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HEALTH  LIBRARY 


UNIVERSITY  OF  CALIFOUNIav 
SCHOOL  OF  PUBLIC  HfcALTH 
3583  LIFE  SCtENCES  BUILDING 


INDUSTRIAL  NURSING 


THE  MACMILLAN  COMPANY 

NEW  YORK   •    BOSTON   •    CHICAGO    •   DAIJ.AS 
ATLANTA    •    SAN   FRANCISCO 

MACMILLAN  &  CO.,  Limited 

LONDON    •   BOMBAY    •  CALCUTTA 
MELBOURNE 

THE  MACMILLAN  CO.  OF  CANADA,  Ltd. 

TORONTO 


INDUSTRIAL    NURSING 

FOR  INDUSTRIAL,   PUBLIC  HEALTH,  AND  PUPIL 
NURSES,  AND  FOR  EMPLOYERS  OF  LABOR 


BY 

FLORENCE  SWIFT  WRIGHT,  R.  N. 

bureau  of  child  hygiene,  new  jersey  state  department  of 
health;  formerly  secretary  of  the  benefit  association 
of  the  employees  of  john  wanamaker,  new  york) 
and  formerly  in  charge  of  industrial  nurs- 
ing for  both  the  cheney  brothers'  silk 
mills  and  the  clark  thread  company 


•N'pm  1  nrk 

THE  MACMILLAN  COMPANY 

1919 

All  rights  reserved 


COPTKIGHT,    1919 

By  the  MACMILLAN  COMPANY 
Set  up  and  electrotyped.    Published  July,  1919] 

Vxibllo  Heal  til  Ii"bo 


PUBLIC 

HFALTH 

FOREWORD  LIBRARY 

To  the  preparation  of  this  manual  many  industrial  nursesj 
have  given  freely  from  their  experience  and  thought. 

It  is  recognized  that  each  plant  and  each  industry  is  a 
separate  problem  requiring  an  elastic  and  flexible  nursing 
service.  It  is  not  too  much  to  expect,  however,  that  there  will 
be  ultimate  standardization  of  certain  necessary  methods, 
records,  equipment,  restrictions,  etc.,  which  will  mean 
greater  efficiency  and  safety. 

Any  standards  worked  out  at  the  present  time  (1919)  will 
doubtless  require  modification  in  the  days  to  come  in  order 
to  meet  future  industrial  and  social  developments. 

The  writer  hopes  to  present  to  pupil  nurses,  and  to  others 
who  wish  to  take  up  industrial  nursing,  an  idea  of  the  condi- 
tions under  which  they  may  have  to  work  and  to  emphasize 
the  need  of  as  thorough  a  training  as  possible.  To  those  who, 
because  the  need  is  urgent  must  enter  the  field  with  little 
more  preparation  than  a  hospital  training,  this  volume  may 
serve  as  a  guide  to  careful  self-preparation  while  engaged  in 
the  work.  It  may  also  give  to  some  employer,  who  still 
doubts  the  value  of  the  trained  nurse  in  industry,  an  idea  of 
what  the  nurse  can  do  for  his  organization,  employes  and 
community. 

Because  the  work  of  the  industrial  nurse  is  so  varied,  be- 
cause she  is  working  in  so  many  different  industries,  and 
because  in  no  two  places  are  her  duties  and  responsibihties 
the  same,  it  is  very  difficult  to  write  about  her  work  in  a 
general  way.  Nurses  are  successfully  employed  in  most 
large  and  in  many  small  industries;  in  mills,  factories,  hotels, 
department  stores,  laundries  and  tanneries,  in  mining  villages 
and  other  industrial  communities,  by  insurance  companies, 
banks  and  trust  companies. 


iw329080 


vi  FOREWORD 

They  are  doing  first  aid  work,  sanitary  inspection,  accident 
prevention  work;  they  are  working  at  employment  problems, 
supervising  lunch  rooms  and  rest  rooms;  they  are  teaching 
first  aid,  hygiene,  home  nursing,  child  care,  EngUsh. 

As  industrial  visiting  nurses,  they  are  caring  for  the  sick  in 
their  homes,  teaching  in  these  homes  the  care  of  children 
and  elementary  nursing  principles;  helping  in  the  making  of 
Americans  from  our  masses  of  foreigners.  They  are  doing  the 
work  of  public  health  nursing  in  communities  where,  without 
them,  httle  would  done  for  the  prevention  of  sickness. 

As  agents  of  their  employers,  they  are  sometimes  acting  as 
health  officers,  tenement  inspectors,  recreation  managers, 
and  school  nurses. 

The  nurse  may  be  employed  by  various  persons;  an  em- 
ployer of  labor,  an  organization  of  employers  of  labor  with 
their  workers,  an  employes'  benefit  association  or  a  labor 
union.  The  term  employer  in  relation  to  the  nurse  will  be 
used  as  meaning  the  person  or  organization  who  has  engaged 
her,  who  pays  her  and  to  whom  she  holds  herself  responsible 
for  the  proper  performance  of  her  duties  and  for  the  welfare 
of  her  patients.  It  seems  wise  to  devote  the  most  attention 
to  the  nurse  in  the  small  plant  whose  duties  have  frequently 
a  wide  range  and  who  is  often  working  alone  except  for  the 
assistance  of  the  company  doctor.  As  the  larger  number  of 
industrial  nurses  are  probably  employed  in  manufacturing 
plants,  the  nomenclature  of  such  concerns  will  be  used. 

The  principles  of  industrial  nursing,  however,  apply  equally 
to  all  branches.  In  a  factory  the  nurse  deals  with  owners, 
general  manager,  heads  of  departments,  foremen,  machine 
hands,  etc.  In  a  department  store  she  deals  with  owners, 
general  manager,  floor  managers,  buyers,  salespeople,  etc. 

For  information,  assistance  and  advice  in  the  preparation 
of  this  manual,  the  writer  is  indebted  to  many  who  have  been 
generous  of  time  and  thought;  among  them  being:  Miss 
Ella  Phillips  Crandall,  Executive  Secretary  of  the  National 
Organization  for  Public  Health  Nursing;  Miss  Mary  S. 
Gardner,  Director  of  the  American  Red  Cross  PubHc  Health 


FOREWORD  vii 

Nursing  Service;  Mrs.  Bessie  Amerman  Haasis,  Educational 
Secretary  of  the  National  Organization  for  Public  Health 
Nursing;  Mrs.  Claribel  Hill  for  assistance  in  gathering  mate- 
rial for  the  records  of  the  nurse  in  the  employment  office; 
Miss  Frances  Young,  Librarian,  National  Organization  for 
PubHc  Health  Nursing  for  assistance  in  the  preparation  of 
the  bibliography;  and  Miss  Ada  M.  Carr,  former  Head  of  the 
Educational  Department  of  the  Boston  Instructive  Visiting 
Nurse  Association,  for  valuable  assistance  in  the  preparation 
of  the  manuscript,  in  the  reading  of  the  proof  and  for  much 
wise  counsel. 


CONTENTS 

CHAPTER  I 

PAGE 

A  Brief  Account  of  the  Development  of  Industrial  Nursing      1 

CHAPTER  II 

The  Qualifications  and  Training  of  the  Industrial  Nurse  ...      9 

CHAPTER   III 
Elementary  Principles  of  Industrial  Nursing 14 

CHAPTER  IV 
The  Industrial  Nurse  and  her  Fellow  Workers 18 

CHAPTER  V 
The  Industrial  Nurse  and  the  Community 28 

CHAPTER  VI 
The  First  Aid  Room  Nurse 32 

CHAPTER  VII 
The  First  Aid  Room 51 

CHAPTER  VIII 
The  Visiting  Nurse  in  Industry 70 

CHAPTER  IX 
The  Day's  Work 81 

CHAPTER  X 

Records  and  Reports  for  the  First  Aid  Room  and  for  the 
Visiting  Nurse 90 


X  CONTENTS 

CHAPTER  XI  „,„„ 

PAGE 

The  Industrial  NtmsE  and  the  Employment  Office,    Records     99 

CHAPTER  XII 
The  Industrial  Nursing  Center 124 

CHAPTER  XIII 
Food.    The  Company  Lunch  Room 142 

CHAPTER  XIV 

A  Few  Questions  which  Mainly  Concern  the  Industrial 
Nurse  Herself 150 

CHAPTER  XV 
What  Iitoustrial  Nursing  Offers  to  the  Nurse 156 

APPENDIX 

First  Aid  Rules 159 

Sources  of  Information  on  Public  Health  Subjects 165 

Bibliography 169 

Index 175 


INDUSTRIAL  NURSING 


INDUSTRIAL  NURSING 


CHAPTER  I 

BRIEF  ACCOUNT  OF  THE  DEVELOPMENT  OF  INDUSTRIAL 

NURSING 

About  the  middle  of  the  last  century  we  see  the  employer 
waking  to  a  sense  of  responsibility  for  the  welfare  of  his 
workers.  In  1842  Dickens  described  what  was  probably 
one  of  the  first  industrial  hospitals  in  the  United  States  ^  and 
in  1852  an  EngUsh  employer  ^  issued  a  report  of  "  The  Educa- 
tional, Rehgious  and  Moral  Charge  to  be  taken  by  the  Com- 
pany over  the  Persons  (and  especially  the  young  persons) 
in  its  Employment."  Many  early  efforts  for  industrial  wel- 
fare were  of  such  a  paternal  nature  as  would  be  scorned 
by  the  average  employe  of  this  generation.^ 

The  Pullman  strike  in  1894  is  often  quoted  as  a  strong 
argument  against  industrial  welfare  efforts.  The  Pullman 
plan  was  instituted  in  1880.  There  was  no  provision  for  a 
nursing  service.  Although  excellent,  and  acceptable  in 
many  ways  to  self-respecting  workers,  its  failure  seems  to 
have  been  due  to  a  paternalistic  attitude  on  the  part  of  the 
employer.  The  effort  to  force  the  purchase  of  suppUes  at 
the  company  store  and  dictation  as  to  the  personal  habits 
of  the  workers  was  probably  the  direct  cause  of  discontent. 

1  "American  Notes",  by  Charles  Dickens,  Chapter  TV. 

2  Price's  Patent  Candle  Company,  Report  1852.  New  York  Public 
Library. 

*  For  a  brief  account  of  the  first  practical  utilization  of  the  trained 
visiting  nurse  for  the  care  of  the  sick  in  their  homes  (William  Rathbone 
in  Liverpool,  1859,  and  the  Woman's  Branch  of  the  New  York  City 
Mission,  1877)  see  "Visiting  Nursing  in  the  United  States,"  Yssabella 
Waters. 


2  INDUSTRIAL  NURSING 

It  is  even  said  that  the  workers  were  not  permitted  to  sit 
on  their  doorsteps  in  their  shirt  sleeves.^ 

Since  1842  we  have  traveled  fast  and  far  and  bid  fair  to 
go  at  a  still  more  rapid  pace  for  some  time  to  come. 

All  through  the  history  of  industry  we  see  the  employer 
(or  more  frequently  his  wife  or  maiden  sister)  visiting  sick 
workers  and  giving  them  advice  or  material  relief,  always 
with  the  idea  of  being  charitable  or  philanthropic.  By 
means  of  a  kindly  despotism  these  visits  sometimes  ac- 
complished much  in  family  crises.  In  any  case,  the  aid 
was  usually  welcomed  as  something  received  for  nothing, 
but  was  often  valued  by  the  recipient  at  its  apparent  cost. 

This  idea  of  the  charitable  employer  clung  to  organized 
industrial  welfare  in  its  early  days,  hindered  its  develop- 
ment, caused  much  misunderstanding  between  capital  and 
labor  and  was  frequently  the  cause  of  discontent  and  ani- 
mosity toward  the  employer. 

The  trained  nurse  probably  first  entered  industry  in  1895, 
when  the  Vermont  Marble  Company  engaged  a  trained 
nurse  ^  to  visit  the  homes  and  care  for  the  sick  workers  and 
their  families. 

In  1897  the  Cadbury  Company  (chocolate  manufacturers) 
in  England  established  a  health  department  which  has  been 
extensively  developed.  The  department  now  provides  phy- 
sicians, trained  nurses,  masseuse,  and  convalescent  homes. 
The  account  of  these  experiments  is  full  of  interest  and  will 
repay  careful  reading.  Many  dangers  of  paternalism  seem 
to  have  been  avoided,  while  the  necessity  of  efficient  medical 
and  health  supervision  in  any  industry  and  especially  in 
food  industries  is  emphasized.^ 

In  1897  the  benefit  association  of  the  employes  of  a  large 

department  store  in  New  York  employed  a  trained  nurse 

to  visit  sick  members  and  see  that  its  funds  were  distributed 

fairly.     It  was  thought  that  her  nursing  experience  would 

iMrs.    Gertrude  Beekes  Easley,    National   Civics   Federation.     A 
quotation  from  memory  of  a  statement  made  by  Mrs.  Easley. 
2  Miss  Ada  M.  Stewart. 
'  "Experiments  in  Industrial  Welfare,"  Cadbury. 


HISTORICAL  SKETCH  3 

enable  her  to  do  this  work  well  and  little  or  no  consideration 
was  given  to  her  ability  to  be  of  help  in  any  other  way.  The 
nurse  employed  ^  found  that  her  nursing  skill  and  ability  to 
give  health  instruction  and  wise  advice  gained  the  confidence 
of  those  she  visited  and  that  only  in  a  few  cases  was  there 
any  question  of  malingering.  Of  these,  many  proved  on 
further  study  to  be  a  real  incapacity  or  a  sincere  but  mistaken 
conviction  of  inability  to  work.  Experience  proved  to  her 
that  her  services  could  best  be  used  by  giving  first  aid  where 
needed,  by  providing  prompt  and  suitable  medical  and 
nursing  care  for  the  sick  and  injured,  by  following  up  the 
cases  to  see  that  medical  orders  were  carried  out,  that  the 
patients  retm-ned  to  their  doctors  when  necessary,  did  not 
return  to  work  before  able  to  do  so  or  while  in  a  condition  to 
be  a  menace  to  their  associates,  and  that  financial  anxieties 
and  family  cares  did  not  retard  recovery. 

The  field  of  the  nurse  in  industiy  is  stOl  fundamentally  the 
one  discovered  by  this  pioneer,  with  the  broadening  and  de- 
velopment which  accompany  the  growth  of  any  agency  meet- 
ing a  distinct  and  long-felt  need.  The  relationship  in  this 
instance  between  nurse  and  patient  was  particularly  happy 
because  the  niu-se  received  her  salary  from  the  funds  of  the 
benefit  association.  She  was  appointed  by  the  elected  rep- 
resentatives of  the  members  and  was  really  the  employ^ 
of  the  workers.  When  this  arrangement  exists  it  is  possible 
for  the  nurse  to  make  occasional  visits  solely  for  investiga- 
tion 2  as  the  workei-s  recognize  the  justice  of  such  visits 
and  their  necessity  for  the  protection  of  their  own  funds. 
Under  any  other  plan  visits  solely  for  investigation  by  the 
nurse  are  of  more  than  doubtful  value.  Where,  however,  she 
is  known  to  be  ready  to  help  and  is  sent  in  a  helpful  spirit  this 
objection  does  not  hold. 

About  the  time  the  trained  nurse  entered  the  field,  far- 
sighted  employers  began  to  reaHze  that  certain  forms  of  in- 

*  Miss  Anna  B.  Duncan,  R.  N.,  former  Secretary  of  The  Benefit 
Association  of  the  Employees  of  John  Wanamaker,  New  York. 
2  See  Chapter  III. 


4  INDUSTRIAL  NURSING 

dustrial  welfare  and  especially  industrial  nursing  are  "good 
business."  The  cost  is  now  quite  generally  charged  to  over- 
head expense  where  formerly  it  was  often  charged  to  charity 
or  occasionally  even  to  advertising.  This  change  of  heart 
in  the  employer  is  nearly  complete,  but  it  sometimes  remains 
for  the  nurse  to  do  her  part  in  bringing  clearly  before  the 
employe  the  motives  and  kindly  aims  of  the  company  for 
which  he  works;  a  task  which  vanishes  when  the  worker  co- 
operates in  establishing  and  managing  the  funds  which  pay 
the  nurse  and  which  provide  his  sick  benefit. 

Various  efforts  have  been  made  to  solve  the  problem  of  the 
sick  worker.  It  has  often  been  a  financial  problem,  but  in 
these  days  of  good  wages  it  is  frequently  solely  a  question  of 
educating  the  worker  in  the  wise  expenditure  of  a  good  income. 
With  workers  from  many  lands  and  from  all  parts  of  our  own 
country  gathered  together  in  industrial  centers,  it  becomes 
necessary  for  the  far-sighted  employer  to  do  his  part  in  mak- 
ing these  heterogeneous  elements  into  an  American  com- 
munity. This  can  best  be  done  through  the  children  in  the 
schools  and  through  the  women  in  the  homes.  The  industrial 
nurse,  as  well  as  other  public  health  nurses,  may  assist  in 
solving  two  problems:  the  making  of  good  American  citi- 
zens as  well  as  the  care  of  sick  workers.  She  teaches  the 
worker  and  his  family  in  plant  and  home  how  to  live  in  order 
to  keep  well  and  how  to  avail  himself  of  proper  medical  care 
when  sick  or  injured.  She  shows  him  that  his  fears  of  hos- 
pitals and  doctors  are  groundless,  persuades  him  to  avoid 
quacks  and  patent  medicines  and  points  out  to  him  the  folly 
of  depending  on  a  kindly  neighbor  for  gratuitous  medical 
advice. 

Efforts  for  the  care  of  the  sick  worker  are  gradually  de- 
veloping into  the  care  of  the  well  worker  himself  to  keep  him 
well,  and  into  the  care  of  his  work  rooms,  house  and  com- 
munity conditions  in  order  to  keep  him,  and  also  his  family, 
in  good  health.  Development  has  been  along  three  lines: 
funds  organized  and  financed  by  the  employer  alone;  those 
organized  and  financed  by  cooperation  between  employer 


HISTORICAL  SKETCH  5 

and  employ^,  each  contributing  a  share  of  the  cost  and  each 
having  a  voice  in  the  administration;  those  organized  and 
financed  by  the  employes  alone,  either  by  the  association 
of  the  employes  of  one  plant  (benefit  associations)  or  by 
labor  unions.  The  most  acceptable  to  the  self-respecting 
employe  seem  to  be  those  funds  to  which  he  himself  con- 
tributes and  in  whose  management  he  has  a  voice,  and  those 
instituted  by  the  employer  as  a  definite  part  of  his  equip- 
ment, as  necessary  in  the  present  state  of  society,  as  walls 
and  a  heating  plant  in  our  cUmate. 

It  is  not  within  the  scope  of  this  book  to  discuss  the  rel- 
ative ^  merits  of  these  different  methods.  While  about  four- 
fifths  2  of  the  states  have  provided  by  legislation  for  at  least 
a  part  of  the  care  and  compensation  of  workers  suffering 
industrial  injury,  none  have  provided  state  administered 
health  insurance  or  pension  systems  in  general  industry.^ 
Until  public  opinion  demands  such  legislation,  employers 
and  employes  will  continue  in  increasing  numbers  to  pro- 
vide funds  for  these  purposes.  By  means  of  experience  so 
obtained  the  necessity  of  uniform  laws  and  provision  by  the 
state  for  health  insurance  andold  age  pensions  is  being  dem- 
onstrated. While  these  systems,  as  now  maintained,  solve 
many  problems  of  the  workers  and  assist  the  employer  by 
reducing  the  labor  turnover,  they  are  often  opposed  by  the 
workers.  Employes  so  provided  for  often  hesitate  to  take 
a  more  promising  position  with  another  company,  knowing 
that  by  so  doing  they  will  lose  claim  to  a  pension  and  possibly 
to  sick  benefit. 

Accident  and  sick  funds,  as  now  administered,  offer  some 
of  the  following  advantages : — 
1.  First  aid  to  the  injured. 

^  "  For  Value  Received,  A  Discussion  of  Industrial  Pensions,"  by  John 
A.  Fitch,  "  The  Survey,"  May  25th,  1918,  Vol.  40,  No.  8,  p.  221. 

-  Statement  from  The  American  Association  for  Labor  Legislation, 
131  E.  23rd  St.,  N.  Y.  City,  June,  1918. 

^  While  Massachusetts  permits  savings  banks  to  sell  insurance,  there 
is  in  this  country  no  provision  for  general  compulsory  health  insurance 
in  any  state. 


6  INDUSTRIAL  NURSING 

2.  Accident  compensation. 

3.  Sickness  compensation  or  health  insm-ance. 

4.  Pensions. 

5.  Death  benefits. 

6.  Medical  care. 

7.  Nursing  care  in  the  plant. 

8.  Nursing  care  for  the  worker  in  the  home. 

9.  Nursing  care  for  the  worker's  family  in  the  home. 

10.  Hospital  care  for  the  worker. 

11.  Hospital  care  for  the  worker's  family. 

12.  Special  care  for  the  tuberculous  worker. 

13.  Medical  examination  of  workers. 

14.  Periodical  reexamination  of  workers. 

15.  Sanitary  inspection  of  plant. 

16.  Sanitary  inspection  of  homes  when  owned  by  the  com- 

pany. 

17.  Loan  funds. 

Maternity  benefits  ^  also  have  been  paid  to  the  mothers  of 
legitimate  children  provided  these  women  entered  the  plant 
at  least  one  year  before  the  birth  of  the  baby  and  remained 
at  home  for  a  certain  time  before  and  after  confinement. 

In  addition  to  the  above,  provision  is  sometimes  made  for 
the  services  of  dentist,  chiropodist,  masseuse  and  mani- 
cure, the  latter  specially  in  food  industries. 

The  entry  of  the  nurse  to  the  plant  has  usually  been  by 

^  Maternity  benefits  to  women  in  industry  deserve  careful  con- 
sideration. They  tend  to  keep  women  at  work  who  should  be  at  home. 
They  encourage  the  early  weaning  of  infants.  Even  though  receipt  of 
maternity  benefit  requires  that  the  woman  should  have  entered  the 
plant  one  year  before  the  birth  of  her  child  and  that  she  stop  work  two 
months  before  her  confinement  and  remain  at  home  six  weeks  after, 
she  goes  back  to  her  work  at  the  earliest  possible  moment,  sometimes 
being  forced  to  do  so  by  her  husband,  both  husband  and  wife  fearing 
that  she  may  lose  a  subsequent  benefit  at  her  next  pregnancy.  Women 
with  several  children  have  been  proud  to  say  that  each  baby  brought 
them  a  benefit  from  their  employer.  They  did  not  relate  this  seeming 
advantage  to  the  doctor's,  druggist's  and  undertaker's  bills,  which  had 
been  paid  on  account  of  these  same  children.  Neither  did  they  think 
of  their  unattractive  homes,  their  hastily  prepared  food  and  possibly 
intemperate  husbands  or  of  their  own  weariness  and  poor  health. 


HISTORICAL  SKETCH  7 

way  of  the  first  aid  room,  but  she  has  seldom  stopped 
there.  She  soon  found  that  the  giving  of  first  aid  was 
one  of  the  least  of  her  duties,  that  it  was  only  one  of  the 
many  ways  in  which  she  found  opportunities  for  service. 
Her  value  in  industry,  both  to  employer  and  to  employe, 
steadily  increased  as  she  entered  into  the  field  of  prevention. 

In  the  plant  she  was  often  able  to  discover  cases  of  illness 
while  in  the  first  stages  and  still  curable.  This  was  most 
frequently  true  in  tuberculosis.  She  was  often  the  first 
person  to  observe  the  early  symptoms  and,  while  she,  of 
course,  made  no  diagnosis,  the  worker  often  accepted  the 
nurse's  statement  that  a  thorough  medical  examination  was 
wise.  She  found  health  and  accident  hazards  and  was  able 
to  secure  their  correction.  She  found  daily  opportunities 
for  teaching  the  workers  in  mattei*s  of  health  and  safety  and 
in  the  necessity  for  early  medical  care  and  prompt  first  aid 
treatment.  In  the  homes  she  was  able  to  do  all  this  and  much 
more.  There  she  found  unlimited  opportunity  to  make  use  of 
all  she  knew  of  housekeeping,  dietetics,  baby  cai-e  and  cook- 
ing. The  growth  of  her  work  was  only  limited  by  time,  by 
her  strength  and  vision,  and  by  the  initiative  allowed  by 
her  employer. 

Accident  insurance,  as  in  force  in  many  states,  has  em- 
phasized the  need  of  industrial  nursing.  Health  insurance 
will  open  to  the  nurse  a  still  broader  field.  As  legislation 
for  accident  compensation  has  lessened  the  number  of  serious 
accidents^  in  industry  while  increasing  the  number  of  re- 
forted  injuries,  so  health  insurance,  when  it  comes,  will 
lessen  the  total  of  industrial  disease  and  other  illness  while 
probably  greatly  increasing  the  number  of  persons  under 
medical  care.  As  the  industrial  nurse  has  been  found  in- 
dispensable in  caring  for  accidents  and  in  their  prevention, 
so  will  the  demand  for  her  services  increase  as  health  insur- 
ance for  the  worker,  whether  provided  by  the  employer,  by 

1-  Mrs.  Florence  Kelley  of  the  National  Consumers'  League  has  been 
heard  to  say  that  the  only  industrial  accident  is  for  a  man  to  be  struck 
by  lightning  while  at  work  and  that  all  other  so-called  industrial 
accidents  are  preventable  injuries. 


8  INDUSTRIAL  NURSING 

the  worker,  by  both  together,  or  by  the  state  with  a  tax  on 
both  employer  and  worker,  becomes  general. 

Whatever  the  final  settlement  of  industrial  problems,  the 
nurse  cannot  be  spared  from  industry.  When  capital  and 
labor  have  learned  that  cooperation  and  mutual  understand- 
ing are  essential  to  human  welfare,  she  will  reach  her  full 
usefulness.  She  will  continue  to  serve  employer,  worker  and 
community  as  long  as  workers  suffer  accident  or  illness  and 
while  the  laws  of  health  are  unknown  or  disregarded  in 
plant,  home  or  neighborhood. 


CHAPTER  II 

THE  QUALIFICATIONS  AND  TRAINING  OF  THE  INDUSTRIAL  NURSE 

It  is  safe  to  say  that  most  industrial  nurses  now  in  the  field 
are  still  pioneers.  There  are,  as  yet,  no  fixed  standards  of 
work  and  few  have  had  training  for  this  particular  branch  of 
public  health  nursing.  The  nursing  profession  finds  itself 
in  the  uncomfortable  position  of  trying  to  meet  the  call  for 
specialized  workers,  with  few  to  respond.  Manj"^  are  being 
equipped  in  the  school  of  experience  but  not  in  sufficient 
numbers  to  meet  the  demands  of  our  present  industrial 
development.  It  is  an  encouraging  sign  of  the  times,  how- 
ever, that  schools  for  nurses  and  colleges  are  beginning 
to  offer  courses  in  preparation  for  industrial  as  well  as  other 
forms  of  public  health  nursing. 

In  the  past  the  industrial  nurse  has  been  obliged  to  get  the 
special  education  she  needed  after  entering  the  work.  While 
any  nurse  must  always  continue  to  increase  her  knowledge 
and  ability  in  any  position,  the  first  steps  will  be  easier  if  she 
ah'eady  knows  a  little  of  what  may  be  expected  of  her,  under- 
stands something  of  industrial  conditions  and  has  an  idea 
of  mistakes  to  be  avoided.  If,  in  addition  to  this,  she  is  an 
all  round  public  health  nurse  she  will  be  able  to  see  and  act 
quickly  upon  opportunities  for  service  and  work  with  a  sure- 
ness  and  confidence  which  will  come  more  slowly  to  the  self- 
trained  pioneer. 

The  time  is  past  or  passing  when  the  employer  asks  solely 
for  "a  nice,  motherly  woman"  as  industrial  nuree.  He  now 
more  often  says,  "We  need  this  work  and  want  it  started 
properly.  Send  us  a  well-equipped,  experienced  person." 
He  looks  to  the  nurse  for  real  help  in  his  problems  and  less 
often  thinks  of  her  only  as  an  almoner,  a  detective,  or  merely 

9 


10  INDUSTRIAL  NURSING 

as  an  assistant  to  the  company  doctor.  He  frequently  re- 
quires some  one  who  can  be  of  intelHgent  assistance  to  the 
company  doctor,  the  emploj^nent  manager,  the  sanitary 
engineer  and  the  statistical  department;  some  one  who  is 
able  to  cooperate  with  all  departments  of  the  plant  and  with 
local  public  health  agencies.  In  plants  where  numerous 
divisions  of  responsibiUty  do  not  exist,  he  sometimes  expects 
her  to  take  upon  her  shoulders  work  which  is  not  exactly 
nursing  but  which  is  of  such  a  nature  as  to  aid  in  the  pre- 
vention of  illness  and  accident.  These  additional  duties  are 
quite  within  a  nurse's  province.  All  progressive  social 
agencies  aim  to  work  steadily  for  the  elimination  of  the  need 
for  theu'  services.  The  medical  profession  is  interesting  it- 
self more  and  more  in  prevention  and  so  partially  doing  away 
with  the  need  of  treatment.  Industrial  nurses,  as  assistants 
to  the  medical  profession,  as  pubHc  health  workers  and  as 
social  workers  must  aim  in  every  possible  way  towards  the 
time,  foretold  by  Florence  Nightingale,  when  nurses  in  gen- 
eral will  become  health  nurses  instead  of  sick  nurses. 

In  addition  to  a  ''sick"  nurse  and  a  "health"  nurse,  the 
worker  needs  a  friend,  who  holds  his  confidence,  and  who, 
on  this  account,  is  able  to  interpret  to  hijn  the  good  will  of 
his  employer.  A  friend  who  has  the  sympathy  and  clear 
insight  into  his  needs  which  will  enable  her  to  act  as  his  im- 
official  representative  and  interpret  him  to  his  employer. 

In  short,  industry  needs  a  good  nurse  with  a  knowledge  of 
methods  of  social  work  in  addition  to  famiharity  with  meth- 
ods of  public  health  nursing. 

Industrial  nursing  must  often  be  accomplished  happily  in 
surroundings  not  ideal.  As  conditions  change,  the  nurse 
must  be  ready  to  develop  new  methods  to  meet  them.  If  she 
loves  her  work,  she  will  always  see  more  to  do  than  her  em- 
ployer has  planned  for  her. 

To  meet  all  these  needs  of  industry,  the  nurse  must  have  a 
healthy,  vigorous  body,  an  understanding  mind  and  an 
adaptable  disposition.  Only  so  endowed,  by  nature  or  dis- 
cipline, will  she  be  able  to  keep  her  courage,  youth  and  zeal. 


QUALIFICATIONS  AND  TRAINING  11 

Industry  has  no  place  for  the  half-trained  woman  unless  she 
is  to  be  confined  within  the  four  walls  of  a  first  aid  room  and 
even  there  she  is  a  potential  source  of  danger. 

The  advantages  of  a  liberal  education  before  hospital 
training  need  no  argument.  The  nurse's  training  school 
should  give  her  the  theory  and  practice  of  first  aid  and 
operating  room  technique,  of  obstetrics,  baby  feeding  and 
dietetics  as  a  part  of  the  required  couise  of  study.  In  the 
third  year  of  training  or  as  a  postgraduate  course,  the  pupil 
should  get  an  insight  into  public  health  nm-sing  in  an  in- 
structive visiting  nurse  association  or  nursing  settlement. 
This  should  give  her  an  idea  of  sanitary  inspection,  anti- 
tuberculosis propaganda,  prevention  of  bhndness,  early  de- 
tection of  cancer,  prenatal  and  baby  welfare  work  and 
school  nursing  in  addition  to  bedside  nursing  in  the  homes  of 
the  people. 

Either  during  her  preliminary  education,  hospital  training 
or  postgraduate  work,  the  nurse  should  get  a  working  knowl- 
edge of  psychology  and  of  civic,  industrial,  social  and  relief 
problems. 

The  writer  has  known  the  necessity  for  a  knowledge  of 
family  budget  making,  for  skill  in  buying,  planning  and  cook- 
ing well-balanced  family  meals,  for  ability  to  devise  suitable 
menus  for  workers'  lunch  rooms,  for  a  facility  in  house- 
keeping, gardening,  sewing,  and  running  an  automobile,  all 
in  addition  to  well-defined  nursing  duties.  Experience  in 
organizing  clubs  and  recreations  has  been  found  useful  by 
other  industrial  nurses.  AbiHty  to  speak  in  public  and  to 
teach  will  add  to  efiiciency. 

Familiarity  with  the  language  of  the  workers  will  often  save 
the  day  in  a  difficult  situation.  Even  one  word  of  a  sick 
man's  own  tongue  makes  him  feel  that  he  is  with  friends. 
With  slight  effort,  any  one  can  learn  a  few  useful  words  and 
phrases  as  they  are  needed.  Where  the  workers  are  largely 
of  one  nationality,  a  little  regular  study  and  the  available 
daily  practice  gives  a  fair  working  knowledge  of  their  lan- 
guage in  a  short  time.    In  a  Uttle  Pohsh  settlement  the  one 


12  INDUSTRIAL  NURSING 

word  (dobra — good)  proved  a  good  beginning  for  public 
health  work.  Later,  with  an  interpreter,  prenatal  hygiene, 
baby  feeding  and  bedside  nursing  were  successfully  taught.  A 
few  new  words  were  acquired  at  each  visit  without  any  effort 
at  study  and  with  spelling  entirely  phonetic.  Every  one  was 
anxious  to  teach  his  own  tongue.  No  one  was  critical.  A  few 
words,  accompanied  by  smiles  and  enthusiastic  gestures,  got 
the  idea  "across"  even  though  the  rules  of  grammar  were 
disregarded.  Miss  Lillian  D.  Wald,  author  of  "The  House  on 
Henry  Street"  has  said  that,  though  a  knowledge  of  the 
language  is  important,  the  patient's  conviction  of  sympathy 
on  the  part  of  the  nurse  transcends  that.  She  rejoiced  that, 
though  she  could  not  speak  all  the  languages,  she  could  smile 
in  twenty-seven  different  dialects. 

The  trained  nurse  considering  service  in  industry  should 
question  herself  carefully  before  deciding  to  enter  the  work. 
Is  she  really  democratic?  Will  she  be  willing  to  remember 
that  she  is  a  fellow  worker  and  a  neighbor  as  well  as  a  friend 
and  counselor?  Will  she  work,  not  so  much  for  industry  as  in 
industry  and  not  so  much  for  the  employer  and  the  worker  as 
with  and  through  them?  Does  she  hke  people  so  well  that 
she  will  listen  willingly  to  their  familiar  gossip,  and  so  in  this 
way  understand  their  own  wishes  and  what  they  recognize  as 
their  own  needs  before  she  tries  to  lead  them? 

While  a  nurse  is  not  expected  to  have  any  great  knowl- 
edge of  industrial  disease,  intelligent  work  demands  some 
famiharity  with  the  subject  and  especially  with  the  dis- 
eases incident  to  the  particular  industry  in  which  she  is 
employed. 

The  proper  handling  of  the  daily  problems  often  depends 
on  ready  familiarity  with  all  provisions  existing  in  com- 
munity, state  and  nation  for  the  care  of  the  sick  or  for  the 
education  of  the  public  in  matters  of  health  and  safety. 

The  necessity  of  constant  stimulus  to  renewed  effort, 
obtainable  by  reading  and  study,  is  evident.  Attendance  at 
meetings  of  the  National  Organization  for  Public  Health 
Nursing,  the  National  Safety  Council  and  frequent  contact 


QUALIFICATIONS  AND  TRAINING  13 

with  other  nurses  doing  similar  work  make  for  increased 
interest,  enthusiasm  and  abihty. 

Practical  experience  or  even  observation  visits  for  nurses  in 
training  are  hard  to  arrange.  Until  nurses  already  in  the 
field  and  their  employers  are  more  ready  to  give  students 
these  advantages,  dependence  for  practical  experience  must 
be  placed  on  a  period  of  service  as  assistant  in  a  well-organized 
industrial  nursing  department.  Such  an  apprenticeship, 
in  any  case,  is  the  best  possible  preparation  for  undertaking 
alone  the  management  of  such  a  department. 

All  work  for  social  and  industrial  progress  will  be  advanced 
by  a  supply  of  nurses,  fitted  for  the  service,  in  sufficient 
numbers  to  meet  the  demands  of  industry. 


CHAPTER  III 

ELEMENTARY   PRINCIPLES   OF   INDUSTRIAL  NTJRSING 

In  her  book  "Public  Health  Nursing,"^  Miss  Mary  S. 
Gardner  lays  down  eight  fundamental  principles  of  pubUc 
health  nursing: 

"1.  That  only  well-trained  nurses  should  be  employed. 

"2.  That  the  nurses  should  not  be  the  distributors  of 
material  rehef. 

"3.  That  there  should  be  no  interference  with  the  religious 
views  of  the  patients. 

"4.  That  the  rules  of  professional  etiquette  should  be 
rigidly  observed. 

"5.  That  cooperation  in  all  its  forms  should  be  recognized 
as  of  primary  importance. 

"6.  That  suitable  and  accurate  records  should  be  kept. 

"7.  That  patients  unable  to  pay  for  nursing  care  should 
receive  free  service,  and  that  those  able  to  pay  for  it  should 
do  so  according  to  their  means. 

"8.  That  the  daily  working  hours  of  the  nurses  should  be 
limited,  in  order  that  good  work  may  be  done  and  they  them- 
selves be  kept  physically  fit." 

Industrial  nursing  is  public  health  nursing  with  additional 
responsibihties,  different  surroundings,  and  perhaps,  in  some 
ways,  more  strict  limitations.  No  one  will  dispute  that 
1,  3,  4,  5,  6  and  8  apply  with  equal  force  to  industrial  and 
other  forms  of  public  health  nursing.  Any  one  in  doubt  on 
the  subject  is  advised  to  read  Chapter  II  of  Fart  I  of  Miss 
Gardner's  book.  There  remain  then  2  and  7.  We  will  en- 
deavor to  show  that,  while  an  industrial  nurse  may  find  it 
necessary  to  dispense  material  rehef,  the  arguments  against 

1 "  Public  Health  Nursing,"  Miss  Mary  S.  Gardner,  page  55. 

14 


ELEMENTARY  PRINCIPLES  15 

the  practice  are  even  stronger  in  her  case  than  in  others  and 
only  when  no  other  course  is  open  should  she  have  recourse  to 
it.  The  industrial  nurse  is  not  in  any  sense  a  charity  worker. 
She  is  employed  as  a  part  of  a  regular  provision  for  the  well- 
being  and  efficiency  of  the  workers.  If  she  allows  herself  to 
be  the  means  of  bringing  in  charity,  she  destroys  her  best 
hold  on  those  she  serves.  If  she  allows  herself  to  be  any1;hing 
but  a  helpful  friend  who  is  also  a  coworker,  she  will  lose  much 
of  her  influence  with  her  patients.  They  will  soon  forget  the 
nursing  care,  helpful  advice  and  teaching  if  they  find  that 
gifts  of  material  value  are  obtainable  through  the  nurse.  It  is 
only  human  to  value  tangible  above  intangible  benefits.  Of 
course  the  workers  of  a  better  and  more  independent  spirit 
will  not  wish  charity,  and,  in  the  long  run  with  all,  the  nurse 
will  gain  nothing  by  a  relation  which  permits  any  other  inter- 
pretation than  that  of  being  considered  one  of  the  generally 
accepted  and  universally  welcomed  provisions  for  industrial 
safety,  health  and  happiness. 

Of  course  no  nurse  will  allow  a  patient  to  suffer  for  the  lack 
of  help.  Some  means  will  be  devised.  The  self-respecting 
worker  appreciates  a  loan  fund,  maintained  by  the  com- 
pany, by  the  workers,  or  by  both  together,  from  which  sums 
may  be  borrowed  in  time  of  need  and  repaid  when  the 
emergency  is  over.  Where  there  is  such  a  fund,  there  is  no 
objection  to  the  delivery  of  borrowed  sums  by  the  nurse. 
Neither  can  any  harm  come  from  the  nurse  taking  to  the 
patient  any  regular  income  such  as  a  salary  allowance  or  a 
sick  benefit.  In  fact  she  should  not  forget  the  possibility  of 
such  relief  being  available  and  she  should  do  all  she  can  to 
secure  its  prompt  and  regular  payment.  One  of  the  best  aids 
in  preventing  the  demoralizing  influences  of  physical  mis- 
fortune is  the  continuation  of  some  sort  of  regular  income  on 
which  dependence  may  be  placed  and  with  which  plans  may 
be  made.  If  the  employer,  benetio  association  or  other  in- 
dustrial reUef  organization  takes  no  responsibility,  as  in  the 
case  of  a  new  worker,  it  may  be  necessary  to  refer  the  sick 
person  or  his  family  to  a  local  relief  agency  or  even  to  town  or 


16  INDUSTRIAL  NURSING 

county  poor  officers.  In  no  case  should  this  be  done  without 
the  consent  of  the  person  concerned  or  without  the  sanction 
of  the  person  in  charge  of  such  matters  at  the  plant  or  in  the 
office  of  the  industrial  reUef  organization,  if  such  exists. 

A  nurse  often  lacks  the  social  training  to  enable  her  to  give 
relief  wisely  and,  even  with  the  training,  her  time  may  usually 
be  better  occupied  if  she  can  find  an  expert  for  this  difficult, 
speciahzed  work. 

We  may  usually  omit  the  question  of  pay  for  services  from 
the  problems  of  the  industrial  nm"se.  If  the  nurse  is  em- 
ployed by  the  company,  it  is  as  a  worker  whose  services  are 
necessary  to  the  efficiency  of  the  other  workers  and  each 
one  should  feel  as  free  to  seek  all  the  help  she  is  allowed  to 
give  as  he  would  be  to  send  for  a  speciaHst  to  make  repairs 
on  the  machinery.  When,  as  sometimes  happens,  the  indus- 
trial nurse  cooperates  with  the  local  visiting  nm-se  association 
for  the  nm^sing  care  she  has  not  the  time  to  give  regularly,  the 
question  of  proper  payment  to  the  association  must  not  be 
forgotten.  If  the  employer  is  willing  to  assume  the  cost  of 
such  visits,  a  report  should  be  made  of  each  case  attended  and 
a  weekly  or  monthly  summary  of  visits  should  be  submitted. 
If  there  is  no  such  arrangement,  the  nurse  will  carefully  ex- 
plain to  the  worker  the  difference  between  the  way  in  which 
she  comes  to  him  and  the  means  by  which  the  services  of  a 
visiting  nurse  are  made  available  to  the  community.  When 
he  understands  the  method  of  support  of  the  visiting  nm-se 
association,  he  will  usually,  if  able,  be  glad  to  pay  according 
to  his  means.  In  case  he  is  unable  to  pay,  a  word  with  the 
superintendent  of  the  association  will  undoubtedly  place  him 
on  the  same  footing  as  others  in  need  of  nursing  care. 

A  ninth  principle  should  be  included  for  the  industrial 
nurse.  She  should  not  be  a  detective.  She  is  useless  in  any 
capacity  but  that  of  an  intimate,  confidential  friend  and 
teacher.  In  industrial  establishments,  there  are  persons  who 
may  think  their  aims  will  be  furthered  and  their  departments, 
or  the  organization  as  a  whole,  strengthened  by  utilizing  the 
nurse  in  such  errands  as  finding  out  the  whereabouts  of  a 


ELEMENTARY  PRINCIPLES  17 

worker,  whether  he  is  drunk,  etc.  The  nurse  will  do  well  to 
nip  such  tendencies  in  the  bud.  She  should  make  it  clear 
that  she  visits  the  worker  only  to  be  of  service  to  him.  If  she 
keeps  this  in  mind,  she  may  be  able  to  help  the  man  she  finds 
intoxicated  and  the  girl  who  has  gone  to  the  picture  show 
when  her  mother  thought  she  was  at  work.  There  are  few 
calls  that  a  nurse  may  not  advantageously  answer  if  she 
remembers  that  she  is  not  a  detective,  and  if  she  impresses 
eveiy  one  with  whom  she  comes  in  contact  with  the  right 
conception  of  her  work.  She  may  acceptably  visit  any  one 
at  any  time  if  she  is  sent  in  a  helpful  spirit,  but  without  this 
purpose  she  cannot  be  expected  to  pry  into  the  affairs  of 
others. 

In  cases  where  malingering  is  suspected,  the  nurse  has  no 
responsibility  at  all.  It  is  a  physician's  business  to  make  the 
diagnosis  of  maUngering  as  well  as  all  other  diagnoses.  The 
nurse's  duty  ends  when  she  has  relieved  discomfort,  carried 
out  the  physician's  orders  for  treatment  and  stated  to  him 
any  symptoms  she  may  have  observed.  The  question  of 
maUngering  is  a  very  small  one.  Many  cases  of  supposed 
malingering  prove  later  to  have  been  obscure  conditions 
often  more  serious  and  harder  to  cure  than  something  which 
was  at  once  self-evident.  Tactful  treatment  by  the  nurse  will 
sometimes  bring  the  diagnosed  malingerer  back  to  work  and 
will  do  much  in  those  not  infrequent  cases  where  the  patient 
needs  to  be  convinced  that  it  will  not  hurt  him  to  take  up 
work  again. 


CHAPTER  IV 

THE  INDUSTRIAL  NURSE  AND   HER  FELLOW   WORKERS 

The  scope  of  the  industrial  nurse's  activities  is  almost  as 
varied  as  industry  itself.  It  ranges  all  the  way  from  definite, 
limited  nursing  duties,  as  part  of  a  large  welfare  department 
under  a  welfare  director,  and  with  the  health  department  in 
charge  of  a  physician,  to  duties  which  include  the  supervision 
of  all  the  welfare  work  done  in  the  plant. 

Large  concerns  often  devote  gi'eat  sums  of  money  to  ex- 
tensive work  for  the  betterment  of  industrial  conditions  and 
the  welfare  of  the  workers  and,  in  such  an  organization,  the 
nurse  may  find  httle  work  for  which  she  has  not  been  prepared 
by  her  training  in  hospital  and  public  health  nursing.  If  there 
is  but  one  nurse,  her  duties  may  be  only  those  of  a  nurse, 
there  being  other  trained  workers  in  the  plant  with  whom  to 
cooperate  for  the  full  welfare  of  her  patients.  If  she  has  the 
supervision  of  other  nurses  she  will  have,  in  addition,  the 
duties  of  an  executive.  She  may  also  have  clerks,  cleaners  and 
other  workers  on  her  staff.  She  often  begins  as  the  only  nm-se, 
being  given  additional  help  as  she  develops  her  work  and 
proves  the  necessity  of  assistance.  There  is  much  to  be  said 
in  favor  of  this  slow  growth  either  in  a  large  or  a  small  plant. 
Many  mistakes  are  avoided  and  the  nmsing  department  is 
better  adjusted  to  the  particular  needs  of  the  industry. 

A  welfare  superintendent,  who  may  be  a  nurse,  often  has 
general  supervision  of  the  employment  department,  sanita- 
tion of  the  plant  and  tenements  of  the  company,  pensions, 
compensation,  sick  benefits,  material  relief  to  workers  in 
financial  difficulties,  care  of  industrial  injuries,  care  of  sick, 
education,  recreation,  etc.  According  to  the  size  of  the 
plant,  there  may  be,  as  assistants  or  co-workers,  a  number  of 
other  trained  workers.    There  will  be  a  physician.    A  social 

18 


THE  NURSE  AND  HER  FELLOW  WORKERS     19 

worker,  a  sanitary  and  safety  engineer,  a  dietitian,  club 
managers  and  other  specialists,  as  well  as  a  nurse,  may  also 
be  on  the  staff. 

It  is  not  necessary  to  go  into  the  organization  of  industries 
further  than  to  show  the  nurse,  whose  experiences  may  have 
been  along  other  lines,  some  of  the  conditions  under  which 
she  may  be  expected  to  work.  The  questions  of  management 
are  handled  in  almost  as  many  ways  as  there  are  kinds  of 
industry.  The  nurse  need  not  trouble  hei-self  with  these 
problems  except  as  they  affect  her  efficiency. 

In  some  industries  the  nurse  may  be  employed  and  paid 
by  the  workei-s  themselves  through  benefit  associations,  or 
other  organizations  of  workers.  This  arrangement  has  many 
advantages.  The  friendly  understanding  between  patient 
and  nurse  is  preairanged.  The  help  of  the  nurse  comes  as 
something  the  patient  has  paid  for  and  he  values  it  accord- 
ingly. However,  any  nm-se,  no  matter  how  paid,  will  have 
no  difficulty  in  gaining  the  confidence  of  those  she  serves,  if 
she  has  an  unselfish  desire  to  help  them. 

In  those  industries  where  the  employes  have  a  voice  in 
making  the  plans  for  their  own  welfare,  the  nurse  is  often 
responsible  to  a  committee  of  workers.  This  necessitates 
legular  meetings  which  should  be  welcomed  by  the  nurse. 
Not  only  will  she  have  stated  times  for  explaining  what  she  is 
doing  and  what  she  would  like  to  do,  but  she  will  have  a  price- 
less opportunity  for  the  advancement  of  her  own  industrial 
education.  The  members  of  the  committee  will  be  able  to 
explain  local  prejudice  and  customs,  assist  the  nuise  in  her 
study  of  industrial  hazards,  and  as  representative  employes, 
give  to  her  efforts  a  backing  hard  to  equal.  The  question  of 
material  relief  is  sometimes  undertaken  by  the  members 
through  these  officers,  much  to  the  satisfaction  of  the  un- 
fortunate but  self-respecting  worker.  Here  the  nm'se  should 
keep  her  hands  off  where  possible,  only  acting  in  an  advisory 
capacity,  and  allowing  the  actual  aid,  unless  a  regular  allow- 
ance, to  come  through  some  other  medium. 

Another  means  of  helpful  conference  is  to  be  found  in  the 


20  INDUSTRIAL  NURSING 

regular  meetings  of  department  heads,  foremen,  safety  ex- 
perts, and  others,  which  are  a  feature  in  the  management  of 
some  plants.  Here  problems  which  touch  more  than  one 
department  are  discussed  and  plans  are  made  by  which  the 
work  of  the  plant  may  be  carried  on  with  the  least  possible 
overlapping  and  friction. 

Other  firms  place  the  consideration  of  all  questions  of 
detail  in  the  hands  of  the  chief  executive.  Each  method  has 
advantages.  The  nurse  must  be  able  to  reach  the  ear  of  the 
committee,  or  the  executive,  or  the  member  of  the  firm 
having  power  to  act  in  behalf  of  her  work.  She  will  soon 
learn  the  wisdom  of  presenting  facts  rather  than  surmises  to 
busy  people  and  will  have  them  carefully  written  out  to- 
gether with  definite  suggestions. 

The  industrial  nurse  cannot  reorganize  the  industry  to  suit 
her  convenience,  and  any  plans  she  may  have  for  the  better- 
ment of  her  work  should  have  the  careful  consideration  of 
herself  and  of  her  associates  before  being  placed  before  an 
executive  meeting,  or  a  busy  general  manager,  or  a  harassed 
employer. 

The  nurse  will  learn  much  from  her  associates.  It  is  true 
that  they  may  also  learn  from  her,  but  her  popularity  will  not 
suffer  by  suppressing  in  her  dealings  with  her  co-workers  her 
desire  to  teach.  She  will  best  obtain  their  liking,  respect,  and 
cooperation  by  showing  plainly  that  she  has  no  wish  either 
to  do  their  work  or  to  show  them  how  to  do  it,  that  she  is  a 
nurse  first  and  that  if  she  attempts  other  work  it  is  only 
because,  at  the  time,  there  is  no  one  else  who  is  better  fitted 
to  carry  it  through. 

This  is  a  good  opportunity  to  say  that  the  nurse  should  be 
very  sure,  before  undertaking  any  work  outside  the  bound- 
aries of  public  health  nursing,  that  no  other  available  worker 
is  better  equipped  for  its  successful  accomplishment. 

In  a  small  plant  or  in  one  with  a  smaller  welfare  depart- 
ment, the  nurse's  duties  may  have  a  wide  range.  In  general 
she  should  be  willing  and,  in  a  measure  prepared,  to  do  what- 
ever needs  to  be  done.    She  should  even  study  the  question  of 


THE  NURSE  AND  HER  FELLOW  WORKERS    21 

administering  material  relief  wisely.  Her  usefulness  may,  at 
some  time,  depend  on  this  preparation. 

The  industrial  nurse  in  the  small  plant  is  apt  to  be  allowed 
a  good  deal  of  initiative.  She  comes  in  closer  touch  with  her 
employer,  who  is  often  the  owner  of  the  plant  and  who  may 
also  be  a  worker  in  it.  He  becomes  familiar  with  her  abilities 
and  is  more  ready  to  take  advantage  of  her  help  in  varied 
problems  than  the  employer  in  a  larger  plant  who  may 
seldom  or  never  see  the  nurse.  Her  work  should  be  such  as 
to  show  the  value  or  necessity  of  each  step  she  takes  and  she 
should  take  care  not  to  waste  her  time,  which  is  her  em- 
ployer's, in  experimentation  and  random  efforts.  Her  rec- 
ords and  reports  will  help  her  to  avoid  these  difficulties. 

The  company  doctor,  at  least  in  states  having  compensa- 
tion laws,  attends  all  industrial  injuries  requiring  surgical 
care.  Some  firms  make  provision  also  for  the  medical  care 
of  the  workers,  and  even  in  some  cases  for  the  care  of  the 
families  as  well.  Benefit  associations  and  mutual  aid  societies 
frequently  make  such  provision  and  some  labor  unions  as 
well.  Industrial  diseases  have  been  construed  by  courts  in 
some  states  as  coming  under  the  same  compensation  rulings 
as  injuries  of  a  violent  nature  and  many  firms  so  treat  them 
without  legal  compulsion. 

Different  arrangements  are  made  by  many  firms  for  the 
medical  attention  required  by  law.  In  small  towns,  where 
the  industry  is  the  reason  for  the  existence  of  the  community, 
the  company  will  often  maintain  a  hospital  for  its  workers 
and  their  families.  The  industrial  nurse  may  have  charge  of 
such  a  hospital.  Where  a  general  hospital,  even  though  in  a 
neighboring  town,  is  available,  many  employers  do  not  wish 
the  responsibility  of  maintaining  their  own  hospitals.  They 
consider,  rightly,  that  the  seriously  injured  worker  will  be 
more  apt  to  receive  the  best  attention  in  an  institution  where 
the  foremost  specialists  of  the  locality  are  on  the  staff. 

Certain  firms  employ  a  physician  for  a  stated  number  of 
hours  daily,  or  at  other  regular  intervals.  In  other  plants, 
one  or  more  local  doctors  respond  to  calls  when  needed. 


22  INDUSTRIAL  NURSING 

Occasionally  all  the  doctors  in  town  are  employed,  the  patient 
being  free  to  choose  among  them. 

The  good  custom  of  employing  the  full-time  services  of  a 
physician  is  growing.  In  large  establishments,  several  doc- 
tors may  be  employed,  together  with  eye,  ear,  nose  and 
throat,  and  other  specialists,  dentists  and  even  chiropodists. 
In  addition  to  the  surgical  and  medical  care  of  the  workers 
in  the  plant,  and  possibly  in  the  homes,  many  firms  require 
the  physical  examination  of  all  new  workers  and  sometimes 
the  reexamination,  periodically,  of  all  employes. 

Contrary  to  common  opinion,  these  examinations  are 
seldom  for  the  purpose  of  excluding  the  handicapped,  except 
where  there  is  danger  of  contagion  to  fellow  workers  or  of 
contamination  of  product.  The  usual  aim  is  to  prevent 
employment  in  an  occupation  dangerous  to  the  employe's 
well-being.  The  reexaminations  make  possible  the  transfer 
of  those  requiring  it  to  more  suitable  work.  They  also  dis- 
cover many  diseases  in  the  early  stages,  while  still  curable, 
frequently  before  the  worker  is  aware  of  his  condition.  Half- 
sick  workers,  discovered  in  this  way,  are  often  treated  in  the 
works  dispensary  or  sent  to  private  physicians  for  conditions 
which  may  be  controlled  in  the  beginning  without  loss  of  time 
or  with  a  short  rest,  but  which,  if  neglected,  might  easily 
prevent  all  work  or  even  prove  fatal.  The  average  worker 
without  medical  supervision  will  endure  what  seems  to  him  a 
slight  illness  until  his  misery  forces  him  to  go  to  a  doctor. 
The  aim  of  most  firms  is  not  to  interfere  with  the  private 
practice  of  local  physicians,  but  to  coopeiate  with  them  in 
raising  the  health  standard  of  the  community. 

In  plants  where  the  examination  of  employes  is  in  the 
hands  of  physicians  connected  with  organizations  of  workers, 
such  as  mutual  benefit  associations  or  labor  unions,  there 
seems  to  be  little  opposition  to  these  examinations  on  the 
part  of  those  benefited  by  them.^ 

^  For  interesting  discussion  of  this  subject,  see  "Physical  Examina- 
tion of  Employes,"  John  B.  Andrews,  Secretary,  American  Association 
for  Labor  Legislation. 


THE  NURSE  AND  HER  FELLOW  WORKERS    23 

"Furthermore,  the  workmen's  present  objections  to  med- 
ical examinations  conducted  by  physicians  hired  by  em- 
ployers would  disappear  when  the  examinations  were  under- 
taken by  a  staff  of  physicians  employed  by  insurance  funds. 
The  loss  of  employment  on  account  of  ill  health  will  be  more 
than  counterbalanced  by  the  opportunities  for  quick  recovery 
when  every  worker  suspended  on  account  of  physical  un- 
fitness will  be  entitled  to  sick  benefit  administered,  not  by  the 
employer  and  his  hired  physician  alone,  but  by  representa- 
tives of  employer,  employe  and  state."  ^ 

An  industrial  physician  for  a  large  plant  has  repeatedly 
stated  to  the  writer  that  the  nurses  were  invaluable  in  ex- 
plaining to  the  workers  the  real  purpose  of  the  physical 
examinations  required  by  the  company  and  in  getting  them 
to  submit  gladly.  They  have  also  succeeded  in  getting 
many  patients  to  come  voluntarily  for  reexamination.  The 
nurses  in  this  plant  had  been  employed  before  the  physician. 
They  had  demonstrated  that  a  full-time  physician  was  a 
necessity  and  their  recommendations  carried  great  weight 
in  the  decision  to  employ  one. 

The  question  of  cooperation  between  the  full-time  com- 
pany doctor  and  the  industrial  nurse  is  usually  solved  by  the 
observance  of  customary  professional  etiquette.^ 

Many  plants,  however,  cannot  have  the  full-time  service 
of  a  doctor.  Unfortunately  some  firms  have  even  considered 
they  had  done  all  that  was  necessary  in  engaging  a  nurse  and, 
most  unhappily  a  nurse  has,  in  a  few  cases,  taken  a  position 
where  there  was  no  physician,  even  nominally,  in  charge 
of  the  medical  and  surgical  work  in  the  plant.  This  has  done 
harm  by  creating  a  misconception  of  industrial  nursing  in  the 
minds  of  physicians  and  in  overemphasizing  to  the  worker 
the  importance  of  the  nurse  from  a  medical  standpoint.  It 
seems  doubtful  if,  at  the  present  time,  any  nurses  of  good 

1  "Physical  Examination  of  Employfe,"  John  B.  Andrews,  Secretary, 
American  Association  for  Labor  Legislation. 

2  The  whole  subject  of  professional  etiquette  is  treated  fully  and 
beautifully  by  Miss  Mary  S.  Gardner  in  her  "PubUc  Health  Nursing," 
Part  I,  Chapter  III. 


24  INDUSTRIAL  NURSING 

standing  are  working  in  industrial  first  aid  rooms  without  a 
physician  to  diagnose,  to  direct  the  treatment  of  cases  and  to 
supply  standing  orders  for  use  in  his  absence.  Even  small 
employers  are  realizing  the  limitations  of  the  nurse  and  are 
availing  themselves,  in  addition,  of  the  services  of  physicians 
at  least  for  part  of  the  time. 

The  doctor  and  nurse  each  has  a  place  in  industry  and  the 
nurse  should  no  more  be  expected  to  usurp  the  doctor's 
office  than  the  doctor  should  be  expected  to  do  the  nurse's 
work. 

Owing  to  the  lax  standards  which  have  occasionally  existed 
in  the  past,  industrial  nurses  should  be  more  careful  than 
others  to  avoid  even  the  appearance  of  giving  medical  or 
surgical  care  without  the  supervision  of  a  physician.  When 
giving  treatment  in  the  absence  of  the  physician,  the  nurse 
should  explain  to  the  patient  from  time  to  time  that  the 
dressing  or  special  treatment  is  given  because  it  has  been 
ordered  by  the  doctor  in  charge.  Patients,  ignorant  of  pro- 
fessional etiquette,  often  cause  misunderstanding  of  the 
nurse  by  boasting  of  her  cleverness  and  declaring  that  she 
knows  more  than  most  doctors.  Even  though  this  is  an  ex- 
pression of  gratitude,  it  must  not  be  allowed.  The  tendency 
can  best  be  overcome  by  seeming  to  ignore  it  and  by  carrying 
on  a  continuous  campaign  of  education.  It  is  also  well  to 
explain  incidentally  the  legal  side  of  the  question. 

The  part-tune  company  doctor  has  sometimes  been  known 
to  present  a  problem  in  accomplishing  good  team  work,  which 
may  be  traced  to  the  financial  arrangements  made  with  him 
by  the  company.  Where  the  part-time  physician  has  a  stated 
salary,  calls  at  the  plant  daily  or  at  other  regular  times, 
responds  to  emergency  calls  and  attends  patients  who  may 
be  referred  to  him,  a  capable  nurse  has  little  difficulty  in 
obtaining  his  support  and  cordial  cooperation.  On  the  other 
hand,  where  the  physician  is  paid  according  to  the  number  of 
dressings  done  or  patients  seen,  he  occasionally  feels,  and 
indeed  has  been  known  to  say  frankly,  that  the  nurse  at  the 
plant  was  taking  money  out  of  his  pocket.    Perhaps  she  was. 


THE  NURSE  AND  HER  FELLOW  WORKERS    25 

This  is  an  indication  for  better  arrangements  with  the  doc- 
tor— not  for  dispensing  with  the  nurse. 

By  giving  prompt  first  aid  and  by  getting  patients  to  the 
doctor  in  time,  the  industrial  nurse  can  prevent  numberless 
infections.  Consequently  much  money  is  saved  to  the  com- 
pany which  would  otherwise  be  spent  for  the  surgical  care  of 
the  workers. 

On  the  other  hand,  by  finding  patients  in  need  of  medical 
attention,  she  increases  the  number  of  his  interesting  cases 
and  gets  many  patients  under  the  physician's  care  while 
something  can  be  done  for  them,  thus  helping  to  increase 
the  value  of  the  doctors  to  the  community.  Workers  speak 
wiUingly  to  a  nurse,  who  is  their  friend,  about  conditions 
which  would  not  otherwise  be  brought  to  a  doctor's  attention 
so  soon.  The  nurse,  in  her  daily  contact  with  the  workers, 
has  the  best  of  opportunities  to  observe  those  in  need  of 
medical  care  and  she  can  usually  persuade  them  to  see  a 
doctor. 

While  the  nurse  is  careful  to  make  no  diagnosis,  to  recom- 
mend no  particular  physician  and  never  to  advise  a  change 
of  doctors,  the  company  physician,  together  with  all  the 
other  physicians  in  the  community,  gets  a  larger  number  of 
curable  patients  and  has  a  better  chance  to  show  the  value  of 
expert  medical  and  surgical  care  than  where  no  nurse  is 
employed. 

The  condition  just  described  is  more  typical  of  a  small  town 
than  of  a  large  city  but  the  difference  is  only  that,  in  a  large 
city,  the  nurse's  work,  being  spread  over  so  great  a  surface, 
is  less  apt  to  attract  attention  and  comment. 

The  majoiity  of  physicians  are  far  above  such  petty  con- 
siderations and  are  too  busy  with  important  things  to  give 
them  a  thought. 

Some  firms  employ  two  or  more  doctors,  allowing  the  in- 
jured worker  to  have  his  choice,  the  doctor  chosen  coming 
to  the  plant,  or  seeing  the  patient  in  his  office  or  in  the  pa- 
tient's home,  the  exact  arrangement  often  being  left  to  the 
judgment  of  the  nurse. 


26  INDUSTRIAL  NURSING 

The  employment  of  several  different  and  not  always  like 
minded  physicians  complicates  matters  for  the  nurse.  Her 
salvation  lies  in  the  cooperation  of  each  doctor  with  all  the 
other  doctors  and  with  her.  Standing  orders  must  be  ob- 
tained for  the  nurse  and  they  must  be  signed  by  all  the  doc- 
tors who  are  employed  by  the  company  to  attend  industrial 
injuries.  This  is  a  difficult  thing  for  the  nurse  to  attempt 
and  may  better  be  done  for  her  by  the  employer.  In  one 
instance,  where  the  first  aid  methods  of  the  three  doctors 
employed  vaiied,  an  employer  submitted  to  them  a  first 
aid  pamphlet  published  by  a  large  safety  organization.  This 
was  only  intended  as  an  illustration  of  something  simple, 
safe  and  practical.  It  was,  with  a  few  additions,  approved  by 
the  doctors.  The  nurse  was  then  able  to  give  first  aid  and 
to  teach  it  to  the  workers,  feeling  that  she  had  the  support 
of  all  the  doctors  employed  by  the  company.  Previously 
she  had  tried  to  work  with  three  sets  of  standing  orders  and 
the  resulting  complications.  Fortunately  no  one  died,  not 
even  the  nurse,  but  harmony  did  not  exist  until  there  was  one 
set  of  standing  orders  approved  by  all  three  doctors. 

To  the  greater  number  of  industrial  physicians,  the  nurse 
has  only  to  prove  her  honesty  of  purpose  and  her  ability  to 
help  them  and  their  patients,  to  be  accorded  hearty  co- 
operation and  support.  Sometimes  this  is  slow  of  accom- 
plishment but,  where  the  aims  and  ideals  of  both  are  the 
same,  it  will  come  in  time. 

The  cooperation  of  the  other  employes  is  as  necessary  as 
that  of  the  physician  and  other  welfare  workers.  A  first 
aid  room  or  dispensary  is  of  little  use  if  the  worker  does 
not  realize  the  importance  of  having  all  injuries  treated. 
A  doctor's  visit  is  a  waste  of  money  if  the  patient  does  not 
do  as  he  is  advised.  Safety  devices  are  of  no  value  when 
out  of  order  or  unused.  The  nuise  must  devise  means  for 
bringing  these  and  other  matters  before  the  workers.  This 
question  will  be  taken  up  more  fully  later. 

If  the  first  aid  room  is  made  democratic  by  the  impartial 
treatment  of  all  workers,  its  popularity  and  value  are  in- 


THE  NURSE  AND  HER  FELLOW  WORKERS    27 

creased.  In  some  plants,  all  persons  connected  with  the 
establishment,  employers,  managers,  office  boys  and  scrub 
women  are  treated,  when  necessary,  in  the  first  aid  room 
and  even  at  times  in  their  own  homes  by  the  visiting  nurse. 
This  pohcy  places  the  medical  or  nursing  department  plainly 
in  the  minds  of  all  as  a  necessary  department  of  the  plant 
and  not  as  a  charity. 

The  industrial  nurse  cannot  reach  her  full  usefulness  with- 
out the  cooperation  of  each  and  every  person  in  the  plant, 
but  if  this  ideal  is  not  attained  at  once  the  nurse  must  neither 
grow  discouraged  nor  abandon  her  efforts. 

It  will  never  help  matters  to  take  sides  in  any  labor  dis- 
turbances or  in  any  disagreements  between  various  factions 
in  the  organization.  The  nurse  should  not  discuss  such  sub- 
jects and  should  keep  her  personal  opinions  to  herself.  Her 
duty  is  to  serve  both  sides  to  the  best  of  her  ability.  Loyalty 
to  her  employer  and  to  her  patients  may  require  her  to  in- 
terpret one  to  the  other  but  she  should  be  neutral,  although 
helpful  in  promoting  peace  and  good  feeling.  Where  the 
nurse  does  not  feel  real  loyalty  to  her  employer,  she  will 
surely  be  more  useful  in  some  other  field  of  effort. 

Even  more  important  than  gaining  of  cooperation  is  giving 
it.  To  be  able  to  cooperate,  we  must  see  things  through  the 
eyes  of  others.  We  must  gain  an  insight  into  the  character 
of  people,  their  early  environment,  their  habits  and  super- 
stitions, their  present  surroundings,  their  abilities  and  op- 
portunities, their  interests,  hopes  and  ambitions. 


CHAPTER  V 

THE   INDUSTRIAL   NURSE   AND    THE   COMMUNITY 

The  importance  of  the  industrial  nurse  as  a  factor  in  the 
community  will  depend  first  on  herself  and  second  on  the 
initiative  allowed  her  by  her  employers.  In  any  case  it  will 
be  a  matter  for  slow  and  conservative  advance  with  strict 
observation  of  the  wishes  of  the  employer. 

The  nurse  should  make  it  one  of  her  first  duties  to  discover 
all  the  resources  of  the  community  which  may  aid  her  in  her 
work.  She  should  compile  a  directory,  if  one  is  not  published 
by  an  organization,  containing  the  names,  addresses,  tele- 
phone numbers  of  health  and  poor  officers,  physicians,  dis- 
pensaries, hospitals,  lodges,  charity  organizations,  baby 
welfare  agencies,  churches,  clergymen,  reliable  housing, 
rooming  and  boarding  agencies,  etc.,  and  any  special  informa- 
tion concerning  them.  In  a  large  city  such  a  directory  may 
often  be  obtained  from  the  charity  organization  society. 
Whether  working  solely  in  the  plant  or  in  the  homes  as  well, 
the  nurse  will  have  frequent  need  of  information  from  some 
of  these  sources. 

Through  her  employer,  the  nurse  may  become  an  important 
factor  in  the  general  community  welfare. 

In  a  small  plant  known  to  the  writer,  the  nurse  busies  her- 
self with  all  sorts  of  civic  problems.  Through  her  employer 
and  with  the  cooperation  of  the  health  department  and  the 
transportation  company,  she  has  been  able  to  secure  shorter 
headway  between  cars  during  rush  hours,  thus  avoiding 
needless  exposure  of  workers  and  much  consequent  illness. 
Through  her  influence,  a  shelter  has  been  built  at  the  trolley 
station.  The  abatement  of  industrial  nuisances,  such  as 
smoke  and  fumes  from  neighboring  plants,  was  secured  by 

28 


THE  NURSE  AND  THE  COMMUNITY  29 

proving  to  the  employer  the  harm  they  were  doing  his  work- 
ers. A  letter  to  the  owners  of  the  offending  property  from 
the  nurse's  employer  was  followed  by  consultation  with 
state  and  federal  health  officials.  With  the  advice  of  these 
experts,  proper  consumers  and  chimneys  were  constructed. 
This  nurse  is  now  arousing  interest  in  an  evening  dispensary 
where  workers  may  secure  medical  care  and  pay  for  it.  In 
her  small  plant,  she  has  time  for  many  things  which  might 
not  be  advisable,  even  if  possible,  for  the  nurse  in  a  larger 
place. 

It  is  possible  for  industrial  visiting  nursing  in  a  small 
community  to  be  done  in  such  a  way  as  to  stimulate  a  desire 
for  a  like  service  for  all  classes  of  the  population,  and  to 
lead  to  the  formation  of  a  visiting  nurse  association  or  even 
to  visiting  nursing  under  the  board  of  health.  Baby  welfare 
work  and  prenatal  care  may  be  quietly  initiated  in  the  same 
way. 

The  industrial  nurse  will,  at  least,  be  able  to  show  what 
good  nursing  is  and  to  set  a  standard  for  such  work  which 
will  do  much  to  prevent  the  employment  in  positions  of  re- 
sponsibility of  untrained  or  half-trained  women. 

An  industrial  nurse,  living  among  the  workers  in  a  house^ 
provided  by  her  employer,  has  a  unique  opportunity  for 
service.  At  the  house  she  may  hold  prenatal  classes,  baby 
welfare  conferences,  little  mothers'  classes,  and  even  teach 
cooking,  sewing  and  English,  In  a  small  town,  the  house, 
while  serving  as  a  community  center,  would  furnish  a  prac- 
tical and  simple  example  of  comfortable  furnishing  and  the 
garden  could  be  used  to  stimulate  the  enthusiasm  and  com- 
petition of  the  neighbors. 

Even  though  the  industrial  nurse  finds  no  opportunity  to 
do  any  of  the  big  things,  she  must  not  fail  to  be  a  good  neigh- 
bor as  well  as  a  good  citizen. 

But  if  her  employer  allows  her  a  reasonable  amount  of 
initiative,  and  if  she  also  has  his  close  and  interested  co- 
operation, she  should  be  a  strong  factor  in  stirring  up  com- 
1  See  Chapter  XII,  The  Industrial  Nursing  Center. 


30  INDUSTRIAL  NURSING 

munity  interest  and  in  keeping  it  fixed  on  the  common  com- 
munity problems  and  should  be  able  to  assist  in  the  solution 
of  many  community  difficulties.  In  a  small  town,  she  should 
find  it  possible  to  demonstrate  the  need  of  prenatal,  infant 
and  child  welfare  work  and  school  nursing;  she  should  be 
capable  of  giving  reasons  for  an  increase  of  local  hospital 
facilities,  especially  for  the  care  of  tuberculous  patients, 
contagious  cases  and  those  self-respecting  people,  forming 
the  majority  of  most  communities,  who  are  not  objects  of 
charity,  but  who,  when  sick,  need  care  as  much  as  the  charity 
cases  and  as  much  as  the  richer  members  of  society.  These 
are  the  people  who  are  able  to  pay  the  actual  cost  of  comfor- 
table care,  but  who  find  the  prices  of  the  private  patients' 
department  of  a  hospital  prohibitive,  or  such  a  tax  on  future 
earnings  that  much  actual  harm  is  often  done  the  patient  by 
the  worries  he  cannot  escape. 

Until  slowly  awakening  public  opinion  writes  health  in- 
surance into  the  laws  of  all  the  states  of  the  union,  the  prob- 
lems of  this  middle  class  (made  up  of  most  of  us)  will  need 
the  thought  of  each  person  who  may  be  able  to  help  in  any 
way,  however  small. 

The  industrial  nurse  cannot  escape  being  a  factor  in  the 
development  of  good  laws  and  in  the  furtherance  of  health 
insurance  because  she  unconsciously  influences  so  many 
people.  She  teaches  the  money  value  of  health  and  dem- 
onstrates by  actual  facts  to  her  employer,  as  well  as  to  the 
worker,  the  benefit  of  even  a  little  attention  to  its  preserva- 
tion. 

In  exerting  an  unobtrusive  influence  in  the  community  and 
in  finding  out  the  needs  and  the  wishes  of  the  people,  a  wide 
variety  of  contacts  is  of  the  greatest  help.  The  industrial 
nurse  who  can  possibly  find  the  time  will  learn  many  things 
by  taking  into  her  life  as  much  as  she  can  of  the  social  fife 
of  the  town.  If  there  is  a  woman's  club,  a  civic  association, 
a  community  council  or  any  organization  which  should  be 
in  touch  with  local  questions,  the  nurse  may  gain  much  by 
becoming  a  member  and  by  taking  an  active  part  in  bringing 


THE  NURSE  AND  THE  COMMUNITY  31 

matters  before  the  organization,  in  getting  them  discussed 
from  all  points  of  view  and  in  preventing  important  questions 
being  "laid  on  the  table"  because  no  one  has  the  courage  to 
tackle  them. 

Sometimes  a  word  to  the  right  person  will  start  the  ball 
rolling  and  no  further  action  on  the  part  of  the  nurse  is 
necessary.  If  the  person  initiating  the  movement  can  be 
placed  in  the  agreeable  position  of  having  thought  of  the 
need  himself,  so  much  the  better. 

We  must  not  forget  that  we  cannot  move  people  along  the 
road  of  progress  one  bit  faster  than  they  see  the  need  of  being 
moved.  We  must  remember  that  the  best  and  most  pro- 
ductive efforts  for  the  improvement  of  any  group  have  always 
had  their  origin  within  that  group.  Individuals,  each  one 
working  for  his  own  good  and  for  that  of  his  fellows,  are 
happier  and  better  people  than  the  same  persons  treated  as  a 
"class." 

So  nurses,  as  individuals,  working  with  and  through  those 
with  whom  they  come  in  contact,  rather  than  for  them, 
cannot  fail  to  further  to  some  extent,  public  welfare  and 
democratic  ideals  as  well  as  public  health. 


CHAPTER  VI 

THE   FIRST  AID    ROOM    NURSE 

The  employer  often  engages  a  nurse  with  the  idea  that  she 
will  be  responsible  for  the  first  aid  room  and  with  little 
thought  of  anj^  further  development  of  her  work.  He  will 
sometimes  tell  her  that  the  number  of  industrial  injuries 
is  small,  perhaps  as  few  as  an  average  of  one  a  week.  Of 
course  he  believes  this  to  be  true  but  inquiry  will  usually 
reveal  that  no  thought  has  been  given  to  the  scratches,  small 
punctures,  cuts,  splinters,  burns,  etc.,  which,  without  a 
nurse's  presence  would  have  no  care,  other  than  possibly 
that  of  the  unskilled  fellow  worker,  unless  serious  conse- 
quences developed.  It  will  also  be  found  that  injuries  of  this 
class,  where  existing  records  make  a  distinction  possible, 
often  cause  a  larger  total  surgical  expense,  a  greater  loss  of 
time  from  work  and  more  annoyance  in  the  settlement  of 
claims  than  all  other  kinds  of  industrial  disability. 

The  first  result  noticeable,  after  the  establishment  of  an 
efficient  first  aid  service,  is  a  tremendous  increase  in  the 
number  of  reported  injuries,  followed  at  once  by  a  marked 
decrease  in  the  number  of  infections  and  of  belated  claims 
for  compensation,  together  with  an  appreciable  reduction 
in  the  expenditure  for  the  care  of  such  cases.  These  later 
results  are  just  what  the  employer  wants,  but  he  may  find 
it  hard  to  reconcile  the  apparent  increase  in  the  numbers  of 
those  injured  until  he  realizes  that  the  desirable  results  are 
only  to  be  accomplished  by  this  means.  "No  break  in  the 
skin  is  too  small  for  first  aid,"  should  be  the  slogan. 

The  foremost  requirement  for  an  efficient,  or  even  a  legal, 
first  aid  room  in  an  industrial  establishment  is  a  physician 
employed  by  the  company  to  care  for  the  cases  of  serious 

32 


THE  FIRST  AID  ROOM  NURSE  33 

industrial  injury  and  to  direct  the  treatment  of  the  small  in- 
juries which  require  little  more  than  first  aid  care.  No  nurse, 
who  values  her  professional  standing,  will  consent  to  carry 
on  such  work  where  there  is  no  doctor  to  assume  the  moral 
and  legal  responsibility  of  medical  and  surgical  treatment  and 
to  direct  the  nurse  in  her  care  of  minor  injuries  and  ailments. 

A  physician,  devoting  a  limited  time  to  the  needs  of  an  in- 
dustry, sometimes  asks  a  nurse  what  standing  orders  she 
requires.  In  such  a  case  she  should  suggest  as  simple  and 
limited  a  list  as  possible,  including  the  care  of  small  breaks 
in  the  skin,  burns,  contusions  and  any  special  small  injuries 
peculiar  to  the  industiy.  The  latitude  allowed  the  nurse 
in  giving  medicines  should  be  rather  less  than  that  often 
peraiitted  by  the  average  physician  accustomed  to  working 
with  trained  nurses. 

After  the  nurse  has  obtained  standing  orders,  she  must 
make  it  plain  that  she  uses  them.  Lacking  the  right  relation 
between  the  doctor  and  the  nurse,  the  patient  is  sure  to 
suffer  from  want  of  confidence,  the  physician  will  not  have 
the  nursing  assistance  he  has  a  right  to  expect,  the  company 
will  be  annoyed  by  a  department  that  does  not  run  smoothly, 
and  the  nurse  will  be  sure  to  suffer  numberless  misunder- 
standings and  discouragements  and  may  even  find  her  posi- 
tion untenable. 

Special  thought  should  be  given  to  the  matter  in  those 
plants  employing  two  or  more  local  doctors  as  described  in 
Chapter  IV. 

On  beginning  industrial  nursing  in  a  plant,  with  only  part- 
time  service  from  a  doctor  and  where  no  such  work  has  been 
done  before,  the  nurse  should  lose  no  time  in  making  herself 
familiar  with  her  surroundings.  If  actual  nursing  can  be 
postponed  for  a  week  or  so,  everything  being  allowed  to  go 
on  according  to  custom,  the  nurse  will  be  able  to  see  how 
much  of  the  old  may  safely  be  preserved  and  what  immediate 
changes  are  necessary.  To  this  end  she  may  request  the 
management  to  allow  some  one,  thoroughly  familiar  with 
every  part  of  the  plant,  to  accompany  her  on  a  tour  of  in- 


34  INDUSTRIAL  NURSING 

spection.  In  this  way  she  can  meet  the  various  heads  of 
departments  and  the  foremen  and  get  an  idea  of  the  geog- 
raphy of  the  plant.  Many  workers  will  find  out  who  she  is 
and  be  more  ready  to  approach  her  later.  She  should,  at 
this  time  or  during  a  subsequent  tour  by  herself,  locate  as 
many  as  possible  of  the  first  aid  outfits  in  the  plant.  She 
may  find  all  sorts  of  most  surprising  materials,  salves  of  all 
sorts  seem  to  be  the  favorites,  and  each  will  be  very  precious 
to  the  one  who  has  accumulated  them  and  who  probably  has 
a  little  following  to  whom  he  ministers.  These  outfits  must 
be  cleared  up  and  out  and  without  hurting  the  feelings  of 
anyone.  Employes  who  are  naturally  interested  in  such 
things  are,  through  their  influence  on  their  fellow  workers, 
valuable  allies  for  the  nurse  if  she  can  get  their  understand- 
ing and  cooperation.  They  often  have  quite  a  name  for 
themselves  among  their  associates  as  being  "as  good  as  the 
doctor"  but  their  very  interest  and  intelligence,  while  dan- 
gerous if  undirected,  often  makes  it  easy  to  convince  them  of 
the  advisibility  of  letting  each  man  stick  to  his  last,  doctor 
and  nurse  as  well  as  cobbler  and  carpenter.  If  the  nurse 
can  teach  these  men,  or  better,  show  them  why  it  is  dangerous 
to  use  shoemaker's  wax,  paint, tobacco  or  what  not  on  wounds, 
she  will  perhaps  have  taught  all  the  workers  in  several  rooms 
through  them.  She  should  remember  that  these  men  have 
cared  for  the  injuries  of  their  fellows,  not  for  personal  gain, 
but  often  at  a  loss  of  valuable  time  because  they  saw  a  need 
which  no  one  else  was  meeting. 

Employer,  foremen  and  many  workers  will  soon  recognize, 
in  the  freedom  of  the  injured  from  infection,  justification 
for  the  presence  of  the  nurse,  but  she  must  not  forget  to 
advertise  her  work.  Publicity  and  advertising  are  necessary 
in  selling  good  industrial  products  and  they  are  no  less  help- 
ful to  the  industrial  nurse  in  enabling  her  to  give  what  she 
has  to  the  greatest  number.  The  rare,  and  probably  pre- 
ventable, spectacular  events  advertise  themselves,  but  the 
necessity  of  painstaking  care  in  seeming  trifles  is  hard  to 
teach. 


THE  FIRST  AID  ROOM  NURSE  35 

In  the  beginning  her  fellow  workers  will  take  an  intense 
interest,  for  a  time,  in  what  the  nurse  is  doing.  Even  in  the 
quietest  and  most  humdrum  establishments,  the  imagination 
of  many  will  picture  her  as  spending  her  time  in  holding 
bleeding  arteries,  in  bandaging  frightful  burns  and  in  other 
hand-to-hand  encounters  with  death  and  disaster.  As  in 
reality  the  spectacular  seldom  does  and  never  should  happen, 
it  is  wise,  before  this  interest  cools,  to  make  a  special  effort 
to  show  the  preventive  work  that  is  being  done  and  its  results. 
In  any  busy  first  aid  room  a  month  or  less  should  give  ma- 
terial for  a  report  which  will  show  that  the  new  custom  of 
having  each  break  in  the  skin  treated  has,  even  though  in- 
creasing the  number  of  reported  injuries,  reduced  to  almost 
zero  the  number  of  infections.  If  her  records  are  carefully 
kept  and  tabulated,  she  should  also  be  able  to  show  that  in- 
fections developing  in  small  injuries  have  followed  the  in- 
terfering treatment  of  the  fellow  worker,  or  neglect  in  applying 
promptly  for  first  aid.  Barring  injuries  requiring  a  surgeon's 
care  because  they  require  more  than  first  aid,  the  writer  has 
yet  to  see  one  infection  develop  where  prompt  first  aid  was 
given  to  the  untouched  wound  by  an  industrial  nurse  and 
where  the  dressing  was  left  undisturbed  until  removed  by  her. 

A  little  story  of  the  first  month  in  the  first  aid  room  may  be 
written  so  as  to  interest  the  workers  if  its  distribution  is 
allowed  by  the  management.  Even  if  only  given  to  the  fore- 
men to  be  posted,  it  will  reach  many,  if  each  foreman  has  been 
made  to  feel  that  he  is  an  important  link  between  the  nurse 
and  the  workers.  The  foremen  will  always  be  the  nurse's 
best  allies.  Without  their  help  and  understanding  she  will 
find  it  hard  to  reach  the  workers. 

Other  means  for  securing  the  attention  of  the  workers  will 
reveal  themselves  if  the  nui-se  is  continually  on  the  watch 
for  chances  to  show  the  preventive  side  of  her  work,  both  in 
the  plant  and  in  the  homes. 

Where  the  company  physician  spends  all,  or  even  a  large 
share  of  his  time  in  the  plant,  he  will  probably  wish  to  devise 
his  own  methods  for  this  sort  of  publicity  and  advertising. 


36  INDUSTRIAL  NURSING 

The  nurse,  however,  is  in  the  best  of  positions  to  assist  him, 
and  most  physicians  in  industry  would  be  glad  to  benefit  by 
her  observations  and  by  the  opportunities  derived  from  her 
close  contact  with  the  workers. 

Employers,  managers  and  department  heads  are  easily 
persuaded  to  make  a  trial  of  having  the  least  injury  treated 
in  the  first  aid  room,  and,  as  soon  as  they  see  the  quickly 
foDowing  results,  become  enthusiastic  champions  of  the 
poUcy. 

It  remains  to  educate  the  rank  and  file  of  the  workers. 
This  is  necessarily  a  never  ending  task.  Old  employes  forget 
or  think  their  own  injuries  of  no  account,  especially  those  who 
have  never  happened  to  have  had  an  infection,  and  new  work- 
ers appear  with  startUng  frequency.  Effort  must  never  be 
relaxed  and  the  foremen  and  others  in  charge  of  workers 
must  never  be  allowed  to  grow  lax.  Notices  in  pay  envelopes 
and  posted  in  conspicuous  places  throughout  the  plant,  talks 
to  the  workers  in  their  work  rooms  at  five  minutes  before 
closing  time,  noon  hour  talks  in  the  lunch  room,  all  help. 
New  ways  of  saying  the  same  thing  must  be  invented  and 
must  be  so  worded  as  to  be  understood  by  every  one.  Stories 
of  the  experiences  of  a  fellow  worker  will  have  more  effect 
than  any  number  of  circulars  from  a  pubHshing  company, 
especially  if  the  worker  will  tell  liis  own  tale  at  an  informal 
meeting.  It  is,  unfortunately,  easy  to  find  the  stories. 
Too  many  instances  occur  in  any  plant  which  illustrate 
the  dangers  of  neglect.  A  rehearsal  of  the  troubles  of  some 
one  who  has  recently  neglected  a  seemingly  slight  injury 
has  all  the  human  interest  of  any  other  gossip  and  is  surely 
a  legitimate  way  of  turning  a  common  human  faihng  to 
account.  These  little  stories  interest  new  comers  also  and 
impress  them  with  the  importance  of  the  first  aid  department. 

Inspirations  for  the  spreading  of  benign  gossip  come  when 
one  is  busiest  and  are  apt  to  be  forgotten.  A  pad  and  pencil 
in  the  pocket  or  a  word  to  the  assisting  clerk  will  "nail" 
the  idea  and  preserve  it  for  future  use. 

Much  educational  work  can  be  done  in  the  ways  described 


THE  FIRST  AID  ROOM  NURSE  37 

and  with  individuals,  but  more  far-reaching  methods  are 
needed.  It  reflects  on  some  one's  forethought  when  a  worker 
appears  with  an  old  wound  badly  infected  and  says  he  did 
not  know  there  was  a  nurse  in  the  plant.  For  the  protection 
of  the  company  as  well  as  for  the  safety  of  the  worker,  there 
should  be  some  sure  way  of  informing  each  new  employ^ 
of  the  provisions  made  by  the  company  for  his  comfort  and 
safety.  Where  possible,  it  is  helpful  for  the  nurse  to  talk 
to  the  new  employes  engaged  each  day.  This  can  be  done, 
if  allowed  by  the  management,  through  cooperation  with  the 
employment  department.  After  the  people  have  once  seen 
the  nurse  and  heard  her  speak,  a  strange  and  unreasoning 
but  common  fear  of  nurses  and  first  aid  disappears.  Where 
such  interviews  are  the  rule,  no  one  can  say  he  did  not  know, 
and  many  infections  will  be  avoided.  Such  a  system  with 
a  well-enforced  rule  that  each  wound,  however  small,  must 
have  first  aid  will  do  much  to  prevent  workers  claiming  com- 
pensation for  injuries  which  happened  at  home  or  elsewhere 
on  Sundays  or  hoKdays.  It  is  often  impossible  to  prove  where 
an  mjury  occurred  unless  it  is  reported  at  once  and,  whatever 
the  final  settlement,  one  side  or  the  other  is  sure  to  feel  that 
justice  has  not  been  done. 

Frequent  visits  to  the  work  rooms  help  to  make  the  nurse  a 
familiar  figure  to  the  workers.  Such  visits  also  give  her  a 
better  acquaintance  with  the  heads  of  departments  and 
foremen  and,  through  them,  a  famiharity  with  the  different 
processes  and  their  hazards.  If  the  nurse  is  careful  never  to 
intrude  at  a  busy  season,  she  will  find  that  all  the  time  she 
can  spare  for  these  visits  will  be  well  spent.  After  acquaint- 
ance with  the  heads  of  departments  and  foremen  has  been 
established,  much  detail  may  be  arranged  over  the  telephone 
but,  in  the  beginning,  every  opportunity  for  getting  in  actual 
touch  with  as  many  people  as  possible  should  be  seized.  It 
may  be  well  to  say  here  that  the  telephone  switch  board  of 
many  establishments  is  a  sort  of  local  newspaper  and  that 
discussion  of  the  personal  affairs  of  any  one  has  no  place  over 
such  wires. 


38  INDUSTRIAL  NURSING 

The  first  aid  nurse  will  find  her  patients  to  be  of  four  gen- 
eral classes: — Small  injuries^  which  no  one  would  think  of 
sending  to  a  doctor  as  they  are  easily  cared  for  in  the  first  aid 
room,  cause  no  loss  of  time  from  work  and  for  the  care  of 
which  most  industrial  physicians  are  glad  to  give  the  nurse 
standing  orders;  more  serious  injuries  which  are  sent  to  the 
doctor  at  once  but  which  are  frequently  sent  back  by  him 
to  the  nurse  with  directions  for  subsequent  care;  patients 
suffering  from  some  apparently  unimportant  physical  dis- 
comfort, making  work  unwise  for  a  time,  who  may  be  relieved 
by  rest,  heat  or  other  simple  means;  acute  medical  or  sur- 
gical cases  which  develop  while  the  patient  is  at  work  but 
with  causes  having  no  apparent  relation  to  his  employment. 

The  greater  part  of  the  work  of  the  first  aid  nurse  will 
usually  be  the  care  of  small  injuries,  mainly  those  which 
would,  if  left  to  the  judgment  of  the  worker,  have  no  care  at 
all,  or  worse  than  none  unless  an  infection  occurred,  and  would 
then  often  be  neglected  until  the  condition  became  such  as  to 
cause  inability  to  work.  We  have  already  seen  how,  in  the 
prevention  of  these  needless  infections,  the  nurse  has  the 
first  chance  to  show  the  value  of  her  work.  Records  will 
usually  be  available  so  that  the  nurse's  first  six  months  or 
year  may  be  compared  with  preceding  similar  periods.  If  a 
capable  industrial  nurse  is  in  charge  of  the  first  aid  work,  the 
results  are  always  the  same — a  marked  saving  in  time  lost 
from  work  and  an  appreciable  reduction  in  the  sum  expended 
by  the  company  for  the  settlement  of  claims  for  infected  in- 
dustrial injuries.  It  should  not  be  the  special  concern  of  the 
nurse  to  reduce  the  medical  bills  of  a  company  except  by 
preventive  work.  It  is  even  true  that  they  may  increase 
after  the  nurse  is  installed  for  she  will  find  many  things,  other 
than  infections,  which  require  the  care  of  a  physician. 
Elaborate  discussion  of  first  aid  methods  would  be  out  of 
place  in  this  volume.    The  industrial  nurse's  hospital  training 

^  Where  the  industrial  physician  does  actual  work  in  the  plant,  the 
nurse  may  possibly  be  expected  by  him  to  attend  injuries  of  a  more 
serious  nature  than  she  would  be  justified  in  handhng  without  his  im- 
mediate presence. 


THE  FIRST  AID  ROOM  NURSE  39 

has  already  taught  her  to  meet  emergencies.  She  knows  how 
to  treat  hemorrhage  and  shock  and  how  to  give  artificial 
respiration.  She  knows  the  necessity  of  aseptic  and  anti- 
septic dressings.  She  will  have  the  standing  orders  of  the 
company  doctor  to  cover  the  daily  dressings  and  the  care  of 
the  sUght  indispositions  of  the  workers. 

It  is  true  that  she  may  be  called  on  to  give  first  aid  to 
injuries  which  are  not  minor  injuries.  She  may  have  to  do 
something  she  has  only  seen  others  do.  She  may  have  to 
meet  an  emergency  in  any  part  of  the  plant  where  conditions 
are  not,  to  say  the  least,  what  she  would  find  in  an  operating 
room  or  in  her  own  first  aid  room.  If  she  keeps  calm  and 
takes  time  to  think,  the  right  thing  to  do  will  reveal  itself  to 
her.  If  she  herself  remembers  and  teaches  others  that  in- 
stant action  is  only  necessary  in  two  conditions,  she  will  save 
much  unnecessary  haste  and  confusion  with  resulting  danger 
to  the  injured  person.  These  two  conditions  are,  first,  profuse 
venous  or  arterial  hemorrhage  and,  second,  arrested  respira- 
tion from  drowning,  electric  shock,  or  asphyxiation  from 
poisonous  gases,  pressure  on  the  throat  or  foreign  body  in  the 
larynx.  1 

Shock  may  need  prompt  attention,  but  this  is  a  condition 
famihar  to  the  well-trained  nurse  and  she  will  see  that  the 
patient  is  warmly  wrapped  and  stimulated,  if  advisable,  while 
the  ambulance  and  physician  are  being  summoned. 

The  first  and  last  warning  to  the  nurse  giving  first  aid  is  not 
to  do  too  much.  First  aid  is  a  temporary  means.  The  nurse 
need  not  consider  the  proper  treatment  of  the  injury  but  only 
try  to  prevent  immediate  dangers  and  to  keep  the  patient  in 
as  good  a  condition  as  possible  until  the  surgeon  can  take 
charge  of  him. 

If  the  first  aid  department  of  the  plant  is  well  organized, 
there  will  be  easily  available  a  supply  of  sterile  gauze  suffi- 

^  Paragraphs  dealing  with  the  treatment  of  industrial  injuries  have 
been  made  purposely  as  brief  as  consistent  with  a  reasonable  prepara- 
tion for  handUng  emergencies.  They  are  not  intended  in  the  least  as 
directions  to  the  nurse  nor  can  they  be  used  to  supplant  the  standing 
orders  of  the  industrial  physician. 


40  INDUSTRIAL  NURSING 

cient  to  cover  a  large  wound,  tourniquet,  splints,  etc.  Of 
course  no  cleaning  of  an  extensive  wound  is  allowed  until 
treatment  is  begun  by  the  surgeon. 

The  more  serious  first  aid  problems,  then,  are  simple  if  the 
nurse  remembers  four  points: — 

1.  Treat  profuse  hemorrhage  instantly. 

2.  Treat  arrested  breathing  instantly. 

3.  Treat  shock  promptly. 

4.  Do  not  wash  extensive  wounds  or  remove  clots.  Cover 
with  sterile  gauze  or  clean  material  while  waiting  for  the 
surgeon. 

Working  slowly,  calmly  and  quietly,  any  well-trained 
nurse  will  do  the  right  thing  at  the  right  time.  If  instan- 
taneous action  is  not  indicated,  she  may  wisely  spend  a  little 
time  in  reassuring  the  patient  and  in  quieting  his  fellow 
workers,  of  course  not  delaying  to  summon  surgeon  or  am- 
bulance as  may  be  required.  If  surgeon  or  ambulance  are 
delayed,  as  is  sometimes  unavoidable,  the  nurse  must  plan 
for  further  necessary  care  of  her  patient.  If  he  can  be  moved 
the  nurse  can  often  get  him  to  the  hospital,  using  some 
available  conveyance.  Much  will  depend  on  local  conditions 
and  on  other  surgical  aid  within  reach.  It  is  well,  in  the 
beginning,  to  have  an  understanding  with  employer  and 
company  surgeon  so  that,  in  case  the  company  surgeon  can- 
not be  reached,  the  nurse  may  be  free  to  do  her  best  in  getting 
for  the  injured  worker  the  care  needed  without  red  tape  or 
unnecessary  delay,  that  whatever  action  she  is  obliged  to 
take  will  have  the  support  of  the  company  and  of  the  com- 
pany physician. 

The  nurse  will  not  forget  to  see  that  the  proper  persons  are 
notified,  the  company  physician,  the  hospital,  the  main 
office  and  the  manager. 

The  next  duty  of  the  nurse,  and  requiring  tactful  treat- 
ment, will  probably  be  to  notify  the  relatives  of  the  injured 
one.  This  must  not  be  left  to  the  excited  and  garbled  re- 
ports of  neighbors.  If  the  nurse  is  unable  to  visit  the  home 
of  the  worker  herself,  she  should,  before  the  closing  hour  if 


THE  FIRST  AID  ROOM  NURSE  41 

possible,  send  a  trustworthy,  sympathetic  and  tactful  person 
with  full  instructions  as  to  just  what  to  say.  No  effort  should 
be  spared  to  give  the  friends  the  exact  truth  and  a  careful 
statement  of  what  has  been  done  for  the  welfare  of  the 
patient. 

The  third  duty,  after  a  serious  injury  or  one  whose  cause  is 
not  clear  to  the  nurse,  is  a  visit  to  the  site  of  the  casualty.  If 
the  employer  allows  the  nurse  to  follow  up  these  cases,  she 
will  add  greatly  to  the  completeness  of  her  records  and  to  her 
intelligent  understanding  of  her  work. 

The  industrial  nurse  working,  at  times,  without  the 
immediate  presence  of  the  doctor  will  do  too  little  rather  than 
too  much  in  the  handling  of  those  cases  of  disability  which 
do  not  seem  to  have  their  origin  in  the  conditions  of  employ- 
ment. She  will,  of  course,  make  no  diagnosis,  will  wisely  be 
slow  in  judging  the  relative  seriousness  of  seeming  trifles,  and 
will  not  be  too  ready  to  administer  even  those  remedies  ap- 
proved by  the  doctor  unless  he  is  present  to  observe  the 
patient.  A  gargle  for  the  throat  may  destroy  the  evidence  of 
diphtheria  for  some  hours.  A  medicine  for  the  relief  of  head- 
ache may  mask  important  symptoms.  Frequent  doses  of 
cathartics  may  form  the  habit  of  depending  on  such  rem- 
edies. The  nurse  should  do  all  she  can  for  these  people  by 
teaching  them  that  regular  habits  and  suitable  food  will  do 
more  for  them  than  drugs.  If  drugs  are  continually  neces- 
sary expert  medical  advice  is  indicated. 

In  most  plants  patients,  other  than  those  injured  in  the 
course  of  their  employment,  are,  when  in  need  of  medical  or 
surgical  care,  referred  to  their  private  physicians.  It  would, 
therefore,  seem  best  to  limit  strictly  the  giving  of  medicines 
in  the  first  aid  room  to  those  needed  in  emergencies. 

Indispositions  which  are  not  relieved  by  rest  and  heat, 
headaches  not  helped  by  rest  and  an  ice  cap  or  hot-water 
bag,  or  any  illnesses  accompanied  by  fever  have  no  place  in 
the  first  aid  room  unless  a  doctor  is  in  attendance  to  take  all 
the  responsibility.  The  industrial  nurse  must  see  that  the 
patient  is  placed  where  he  will  have  care;  at  his  own  home,  at 


42  INDUSTRIAL  NURSING 

a  hospital,  or  even  at  a  friend's  house,  and  arrange  for  medical 
attention.  Patients  should  not  be  sent  home  unless  the  nurse 
is  sure  that  some  one  will  be  at  hand  to  give  the  necessary 
care.  When  the  industrial  nurse  has  little  time  for  visits, 
the  local  visiting  nurse  association  will  often  cooperate  in  the 
care  of  such  patients,  and  the  help  of  neighbors  is  not  to  be 
despised.  It  is  often  an  advantage  for  the  nurse  to  accom- 
pany these  patients  home,  but  in  any  case  an  intelligent  per- 
son should  go  with  a  sick  patient.  An  automobile  for  the 
use  of  the  nurse  is  of  great  help  in  getting  sick  persons  out  of 
the  plant,  and  it  can  be  used  instead  of  an  ambulance  for 
many  hospital  patients. 

Patients  sent  home  should  be  followed  up  by  the  nurse  to 
insure  proper  care  and  to  prevent  the  spread  of  possible 
contagion. 

Patients  coming  to  the  first  aid  room  repeatedly  for  seem- 
ing trifles  should  have  careful  watching.  A  study  of  the 
record  of  a  worker  sometimes  reveals  a  surprising  number  of 
hours  spent  in  the  rest  room.  Examination  by  the  physician 
will  often  reveal  abnormal  conditions  which  may  be  cor- 
rected or  which  may  be  relieved  by  change  of  work.  The 
industrial  nurse  should  be  prepared  to  give  simple  eye  tests, 
thus  being  able  to  prove  to  the  worker  his  need  of  the  atten- 
tion of  an  oculist  and  to  prevent  his  employment  where 
normal  vision  is  indispensable. 

Hysteria,  if  frequent  or  not  explainable  by  some  recent 
strain,  should  also  have  careful  medical  attention.  Young 
girls,  suffering  excessive  periodical  pain  are  often  the  most 
numerous  applicants  for  relief.  Nurses  can  do  much  for  some 
of  these  girls  by  cooperation  with  a  local  hospital  having 
women  physicians  on  the  staff. 

Much  preventive  work  is  possible  in  the  first  aid  room. 
Cases  presenting  the  early  symptoms  of  cancer,  tuberculosis 
and  mental  disturbance  will  be  seen  by  the  nurse,  not  to  men- 
tion those  showing  the  often  indefinite  warnings  of  other 
approaching  illnesses,  excessive  nervous  strain  and  over- 
work.   Recognition  of  these  symptoms  by  the  nurse  will  lead 


THE  FIRST  AID  ROOM  NURSE  43 

to  consultation  with  a  doctor  before  more  serious  conditions 
have  time  to  develop.  In  order  to  understand  many  of  the 
cases  the  attending  doctor  must  have  a  knowledge  of  home 
environment  and  outside  activities,  and  the  industrial  nurse 
should  do  her  part  in  getting  this  inforaiation  before  him. 

No  matter  what  the  origin  of  the  troubles  which  bring  the 
workers  to  the  first  aid  room,  the  removal  of  the  cause  is  only 
delayed  by  the  promiscuous  administration  of  drugs.  Some- 
thing is  wrong,  either  in  the  health  or  habits  of  the  worker,  in 
his  work  itself  or  in  his  surroundings  or  associates.  It  is  the 
nurse's  business  to  discover  the  cause,  whether  late  hours  or  a 
poorly  planned  diet,  approaching  illness,  work  which  strains 
poor  eyes,  an  unhappy  home,  a  nagging  foreman  or  what  not. 
Repeated  visits  to  the  first  aid  room  cause  much  loss  of  time 
to  worker  as  well  as  to  employer,  and  both  will  gain  if  the 
nurse  can  help  the  worker  to  a  better  adjustment  to  his  sur- 
roundings. He  should  be  encouraged  to  solve  his  own 
problems.  Sometimes  he  may  need  a  good  deal  of  help,  but 
the  more  he  is  given  the  moral  courage  to  do  for  himself,  the 
better  for  him.  The  workers  must  not  be  led  to  depend  too 
greatly  on  the  nurse  in  any  matter.  It  is  easy  to  make  some 
people  so  dependent  on  the  will  of  others  that  they  become 
unable  to  make  the  simplest  decisions  for  themselves. 

Toothache  is  a  common  first  aid  room  complaint.  The 
patient  wants  rehef  but  he  seldom  wants  to  go  to  the  dentist. 
As  the  giving  of  remedies  simply  postpones  the  cure,  it  seems 
better  to  have  at  hand  no  remedies  at  all  for  toothache  and  to 
insist  on  each  patient  going  at  once  to  a  dentist.  If  the  em- 
ployer provides  the  services  of  a  dentist,  his  relation  to  these 
cases  is  the  same  as  that  of  the  company  physician  to  the 
medical  and  surgical  cases.  Where  no  such  service  is  at 
hand  the  nurse  must  depend  on  cooperation  with  the  local 
dentists.  If  it  is  not  possible  to  make  a  dental  appointment 
or  if  the  patient  cannot  leave  his  work,  it  may  be  desirable  to 
make  some  application  for  the  relief  of  pain,  but  the  oftener 
this  is  done  the  greater  the  difficulty  in  getting  all  patients 
to  have  their  teeth  put  in  order. 


44  INDUSTRIAL  NURSING 

Workers,  and  others  who  should  know  better,  sometimes 
ask  impossible  services  of  the  nurse  and  may  even  accuse  her 
of  lack  of  sympathy  when  she  refuses  them.  Much  tact  and 
patience  are  needed  in  explaining  the  relation  of  the  doctor 
and  the  nurse,  and  it  sometimes  takes  much  persistence  to 
persuade  the  patient  to  consult  the  doctor  when  he  has  ex- 
pected the  nurse  to  cure  him.  The  absolute  difference 
between  the  training,  responsibility  and  duties  of  physician 
and  nurse  must  be  explained  again  and  again  to  the  worker 
and  to  his  friends.  No  matter  how  isolated  the  nurse  or  how 
far  from  a  doctor,  the  nurse  must  keep  this  distinction  in 
mind  and  must  strictly  limit  her  ministrations  to  the  min- 
imum necessary  for  the  well-being  of  her  patient  until  the 
necessary  medical  aid  can  be  obtained. 

The  control  of  contagion  must,  in  times  of  epidemic,  be 
considered  by  the  nurse.  In  a  large  plant,  efficient  control 
will  depend  quite  as  much  on  the  cooperation  and  intelli- 
gence of  the  foremen  in  the  work  rooms  as  on  the  doctor  and 
the  nurse.  An  outbreak  of  "pink  eye"  may  reach  alarming 
proportions  in  a  short  time,  or  an  epidemic  of  influenza  may 
spread  until  the  plant  must  be  closed  unless  each  worker  is 
closely  observed  each  day  and  all  who  show  symptoms  of 
illness  are  excluded  from  the  plant  and  so  cared  for  outside 
that  they  are  not  likely  to  infect  others. 

All  employes  having  the  direct  oversight  of  others  should 
be  taught  to  recognize  the  symptoms  of  "  colds,"  which  are  so 
often  the  first  symptoms  of  the  infectious  diseases.  They 
should  be  made  to  realize  the  importance  of  having  the 
physician  see  such  cases  in  order  to  prevent  the  exposure  of 
others  to  a  possible  danger.  With  the  physician  in  the  plant, 
the  responsibility  for  the  control  of  contagion  rests  with 
him,  but  where,  as  in  many  plants,  the  physician  attends  only 
to  industrial  accidents,  the  nurse  will  have  a  heavy  respon- 
sibility. Until  the  employer  is  convinced  of  the  advantages 
of  more  careful  medical  supervision  in  the  plant  by  a  physi- 
cian, the  nurse  will  often  depend  for  cooperation,  in  the 
prevention  of  contagion,  on  the  support  of  the  local  health 


THE  FIRST  AID  ROOM  NURSE  45 

department  and  on  the  help  of  the  private  physicians  of  her 
patients. 

In  a  very  small  plant  the  nurse  may,  in  times  of  epidemic, 
be  able  to  see  each  worker  daily,  take  his  temperature,  ob- 
serve his  eyes,  nose,  mouth  and  throat,  and  exclude,  before 
he  enters  the  work  room  any  employe  showing  suspicious 
symptoms.  In  most  plants,  this  plan  would  be  impossible 
^  and,  if  any  regular  inspection  were  made,  it  would  have  to 
be  done  by  persons  instructed  by  the  nurse.  Workers  show- 
ing sjonptoms  of  illness  would  then  be  seen  by  the  nurse  and 
sent  to  their  family  physicians,  or  other  arrangements  made 
for  their  care. 

Aside  from  the  cases  of  physical  disability  already  de- 
scribed, the  industrial  nurse  will  be  consulted  in  all  sorts  of 
social  questions.  Unless  the  nurse  can  pass  these  people  on 
to  a  trained  welfare  worker  she  must  do  all  she  can  to  help 
them.  The  very  fact  that  she  has  helped  them  in  their  ill- 
nesses makes  them  prefer  her  help  to  that  of  others  in  their 
other  troubles.  A  nurse  who  is  allowed  to  handle  these  cases 
gains  another  pomt  of  mutual  interest  and  if  she  has  pre- 
pared herself  by  a  study  of  social  questions,  both  nurse  and 
patient  will  benefit  by  this  different  contact. 

Mothers  having  children  to  support  may  need  to  be  told 
how  to  secure  a  mother's  pension  or  require  help  in  getting 
support  from  a  deserting  husband.  Men  and  women  may 
need  to  change  their  boarding  places.  Workers  suffering 
from  tuberculosis  will  need  to  be  informed  of  the  means 
available  for  their  treatment  and  to  be  assured  that  their 
famihes  will  not  suffer  from  the  idleness  of  the  bread-winner. 
Foreigners  will  want  to  learn  Enghsh.  Young  people  will 
ask  about  evening  study.  A  parent  whose  child  is  employed 
by  the  company  may  be  anxious  as  to  his  future,  may  think 
there  is  reason  to  distrust  the  influence  of  some  fellow  em- 
ploye. Almost  any  social  question  may  come  up.  While  the 
industrial  nurse  will  not  have  time  to  go  into  the  business  of 
looking  up  deserting  husbands  or  holding  night  schools,  she 
should  know  if  there  are  local  agencies  filhng  these  needs. 


46  INDUSTRIAL  NURSING 

If  no  agencies  exist  she  should  store  all  facts  in  her  records  and 
be  ready,  if  she  has  a  chance,  to  present  reasons  for  the 
establishment,  in  the  community,  of  what  is  needed. 

The  unmarried  pregnant  woman  in  industry  is  sometimes, 
although  not  so  often  as  is  commonly  supposed,  a  problem 
requiring  the  attention  of  the  industrial  nurse.  Here  she  will 
have  need  of  all  her  sympathy,  understanding,  resourceful- 
ness, tact  and  even  courage.  The  girl's  associates  and  family, 
the  mother  to  be  and  her  baby,  the  guilty  man  or  perhaps 
ignorant  boy,  the  girl's  own  character,  must  all  be  considered. 
This  is  no  place  for  the  usual  records  and  reports,  although, 
if  conditions  of  the  industry  have  any  bearing  on  the  possi- 
bihty  of  such  occurrences,  the  nurse  must  recognize  her 
responsibility  in  prevention  by  making  a  prompt,  frank  and 
detailed  report  to  the  person  or  persons  most  Ukely  to  be 
able  to  change  the  conditions.  Unless  she  is  permitted 
freedom  in  helping  the  workers  in  their  personal  affairs  the 
nurse  can  be  of  little  lasting  comfort  to  the  girl,  but  she  can 
at  least  make  her  departure  from  the  plant  as  inconspicuous 
as  possible  and  she  can  give  the  girl  the  assurance  that  every 
one  will  not  condemn  her  wholly.  Whether  the  man  should 
marry  the  girl  is  an  open  question.  Some  girls  refuse  to  see 
him  and  scorn  his  support.  No  one  has  yet  made  any  rules 
for  helping  these  girls.  Those  who  are  not  essentially  im- 
moral often  bear  their  own  burdens  and  are  unknown  to  the 
agencies  which  exist  for  the  care  of  "fallen  women."  Any 
public  health  nurse  of  long  experience  must  know  more  than 
one  unfortunate  mother  who  has  supported  herself  and  her 
child  and  who  has  forced  her  neighbors  to  respect  her.  Aside 
from  the  mentally  deficient  each  case  presents  a  different 
set  of  factors  and  must  be  handled  differently  from  any  other 
case.  The  mentally  deficient  girl  should,  of  course,  be 
segregated  if  there  is  any  way  to  do  it  and  the  nurse  has  a 
responsibility  in  seeing  that  this  is  accomplished. 

If  the  girl  can  be  persuaded  to  tell  her  mother  and  if  the 
nurse  can  make  sure  of  the  mother's  understanding  and 
sympathy,  the  girl's  future  will  often  be  safest  in  her  hands. 


THE  FIRST  AID  ROOM  NURSE  47 

But  many  mothers  are  far  from  gentle  with  the  daughter.  A 
girl  may  find  her  own  solution.  During  pregnancy  she 
usually  thinks  she  will  hate  the  baby  but,  if  she  has  the  care 
of  it,  she  is  pretty  sure  to  love  it.  The  industrial  nurse  dis- 
covering such  a  girl  cannot  do  less  than  encourage  her  as 
much  as  possible  and  help  her  to  go  through  her  pregnancy 
and  keep  her  child.  It  is  seldom  comfortable  for  the  girl  to 
return  to  her  former  place  of  employment. 

As  the  efficiency  of  the  first  aid  room  becomes  evident,  the 
work  will  become  more  closely  related  to  the  other  de- 
partments and  the  help  of  the  nurse  will  be  asked  in  other 
than  first  aid  problems.  As  it  is  realized  that  the  nurse  has 
the  confidence  of  the  workers  she  will  be  asked  to  handle  all 
sorts  of  delicate  and  confidential  situations  for  their  benefit. 

For  the  convenience  of  the  workers  in  consulting  the  nurse 
about  their  personal  problems,  the  first  aid  room  should  be 
open  during  the  noon  hour.  This  time  should  be  kept,  as  far 
as  possible,  for  the  workers  themselves  and  should  not  be 
used  for  routine  work  in  the  care  of  industrial  injuries,  which 
can  be  done  during  working  hours.  The  nurse  must  not 
neglect  to  set  aside  some  other  regular  time  for  her  own 
luncheon. 

While  the  workers'  temptations  to  make  needless  visits  to 
the  nurse  are  not  great,  unless  the  company  allows  pay  for 
time  spent  away  from  work  rooms,  care  should  be  taken  that 
justice  is  done  the  company  and  that  no  one  is  pampered. 
Idle  machines  plus  idle  workers  mean  a  large  loss.'  Where 
time  is  allowed  the  workers  to  see  the  nurse  on  their  own 
errands,  feelings  of  honor  often  prevent  imposition  and  the 
privilege  is  valued  and  seldom  abused.  The  nurse's  oflBce  and 
the  rest  room  are  not  charitable  institutions,  hospitals,  or 
places  of  amusement.  Patients  who  are  really  ill  should  be 
taken,  as  soon  as  may  be,  where  they  can  have  care.  The 
few  who  come  to  the  nurse  for  change  of  scene  should  have 
short  shrift. 

There  is  also  the  question  of  the  nurse's  own  time.  It  is 
easy  to  fritter  it  away  in  unavailing  conversations.     The 


48  INDUSTRIAL  NURSING 

precious  and  all  too  short  noon  hour  may  be  wasted  on  the 
curious  or  on  the  self-centered  individuals  who  love  to  talk 
about  themselves.  Fortunately  the  latter  class  is  small 
among  those  who  work  with  their  hands.  In  trying  to  weed 
out  the  unprofitable  conversationalists,  the  nurse  must  not 
forget  that  she  can  learn  much  by  listening  and  that  even 
gossip,  carefully  checked  up  and  remembered  but  not  re- 
peated, may  be  a  valuable  factor  in  her  usefulness  to  others. 

Personal  instruction  in  hygiene  to  individual  workers  may 
be  carried  on  almost  continuously  but  with  any  large  number 
of  employes  this  kind  of  teaching  does  not  reach  far.  Some 
firms  are  willing  to  have  short  talks  given  during  work  hours 
in  the  work  rooms.  If  adapted  to  the  inteUigence  of  the 
workers  this  is  a  good  means  of  spreading  knowledge.  In  a 
small  town  evening  classes  are  sometimes  possible,  but  with- 
out assistance,  the  time  and  effort  necessary  are  too  great  a 
tax  on  the  strength  of  the  nurse.  Sometimes  the  company 
doctor  will  carry  on  such  a  campaign  of  education. 

Where  assistance  can  be  had,  the  noon  hour  offers  valuable 
opportunities  for  the  education  of  the  workers.  A  talk  by  a 
dentist  one  week,  one  by  the  company  doctor  another  week, 
a  talk  to  women,  one  to  girls,  a  lecture  from  a  baby  speciaHst, 
lessons  in  the  home  care  of  the  sick  and  numberless  other 
subjects  will  interest  the  workers  and  give  them  something 
that  will  be  of  practical  help  to  them  in  their  daily  lives.  In 
some  plants  instruction  is  provided  by  the  workers  them- 
selves through  self-managed  clubs.  With  a  leader,  such  a 
club  may  be  made  practically  self-supporting  and  will  hold 
the  interest  of  its  members  better  than  voluntarily  attended 
and  unorganized  classes.  Cooperation  with  schools,  health 
board.  Young  Men's  Christian  Association,  Young  Women's 
Christian  Association,  will  sometimes  provide  needed  in- 
struction outside  the  plant  as  well  as  during  working  hours. 
Here  the  temptation  will  be  to  use  time  for  the  benefit  of 
others  which  is  sorely  needed  by  the  nurse  for  her  own  rest, 
recreation  and  development.  Eflaciency  is  best  preserved  by 
keeping  "fit"  mentally  as  well  as  physically,  and  no  one  can 


THE  FIRST  AID  ROOM  NURSE  49 

do  this  indefinitely  whose  Hfe  holds  no  place  for  the  inde- 
pendent pursuit  of  relaxation,  pleasure  and  inspiration. 

Some  firms  expect  the  nurse  to  teach  the  workers  first  aid 
methods.  If  the  employes  are  expected  to  use  what  they 
have  learned  in  the  care  of  their  fellow  workers,  time  is  usually 
allowed  during  working  hours.  Should  the  responsibility 
of  the  workers  in  the  care  of  injuries  be  beyond  the  direct 
control  and  constant  supervision  of  the  nurse,  wisdom  would 
suggest  that  some  other  person  give  all  instruction  and  as- 
sume all  responsibility  for  the  work  of  these  lay-persons.  A 
nurse  is  fully  justified  in  refusing  to  be  responsible  for  more 
than  she  can  closely  supervise.  Workers  trained  in  first  aid 
are  sometimes  careful  and  trustworthy,  but  they  are  too 
prone  to  take  chances,  to  underestimate  the  gravity  of  an 
injury  and  to  be  a  continual  source  of  anxiety. 

The  industrial  nurse  will  sometimes  find  that  she  has  a 
number  of  points  of  contact  with  legal  matters.  In  states 
without  smoothly  working  compensation  laws,  she  may  be 
called  as  a  witness  in  the  settlement  of  claims  for  compensa- 
tion for  industrial  injuries.  Proper  behavior  in  this  event 
consists  in  giving  direct  replies  to  direct  questions  while 
under  oath  and  in  making  no  comments  on  the  case  when 
not  on  the  witness  stand.  If  a  question  is  not  direct  or  is  not 
imderstood  no  answer  should  be  made  until  the  judge  has 
said  that  the  question  is  in  proper  form.  The  witness  stand 
is  no  place  for  conjecture.  A  prompt  and  exact  statement  of 
facts  by  the  nurse  in  her  records  may  be  the  means  by  which 
a  just  decision  is  reached. 

In  many  plants  the  nurse  has  a  large  responsibility  in 
carrying  out  the  provisions  of  industrial  laws.  Her  em- 
ployer may  expect  her  to  take  charge  of  accident  reports.  If 
she  has  any  relation  to  the  employment  office  she  will  prob- 
ably be  responsible  for  seeing  that  other  labor  laws,  espe- 
cially in  regard  to  the  employment  of  women  and  children, 
are  carried  out.  If  she  is  expected  to  inspect  the  plant,  her 
employer  may  depend  on  her  to  bring  to  his  attention  any 
violation  or  evasion  of  laws  for  the  safety  and  sanitation  of 


60  INDUSTRIAL  NURSING 

industrial  plants.  To  meet  these  responsibilities,  and  even 
for  intelligent  daily  work,  the  industrial  nurse  should  make 
herself  familiar  with  the  laws  of  the  state  in  which  she  is  em- 
ployed which  affect  industry,  the  laws  controlling  the  em- 
ployment of  minors,  the  work  of  women,  the  minimum  air- 
space requirements  per  person,  the  provision  and  use  of 
seats,  the  precautions  required  by  law  in  the  dangerous 
trades  and  any  other  matters  directly  affecting  workers. 


CHAPTER  VII 

THE    FIRST    AID    ROOM: — LOCATION,    PLAN,    EQXnPMENT,    ETC. 

The  importance  of  a  conspicuous  and  accessible  location 
for  the  first  aid  room  will  be  appreciated  by  any  one  who 
knows  the  average  worker  and  his  frequent  lack  of  observa- 
tion as  to  his  surroundings.  Where  the  plant  is  in  one  build- 
ing or  in  a  compact  group  of  buildings  one  first  aid  station 
may  be  all  that  is  necessary.  This  is  the  ideal  arrangement. 
In  plants  where  several  stations  are  needed  a  nurse  in  each 
would  make  for  safety,  but  we  cannot  always  have  the  ideal 
and  good  work  must  be  done  with  the  facihties  at  hand.  The 
first  aid  room  or  rooms  should  be  so  located  as  to  be  within 
sight  of  the  workers  as  they  go  to  and  from  their  work  and 
should  be  in  as  central  a  situation  as  possible,  equally  acces- 
sible from  all  parts  of  the  plant.  The  main  room  at  least 
should  be  where  it  can  be  kept  open  at  the  noon  hour.  There 
should  be  room  for  present  needs,  and  future  developments 
are  usually  easier  where  some  thought  is  taken  for  groAvth. 
It  is  unwise  to  change  the  location  of  the  first  aid  room,  as 
familiarity  of  the  workers  with  the  place  is  a  large  factor  in 
their  willingness  to  use  it  freely. 

A  waiting  room  will  be  needed  and  an  office  for  the  nurse 
where  she  may  talk  privately  with  those  who  ask  her  advice 
or  who  may  have  been  sent  to  her  for  help.  Surgical  dressings 
and  assisting  the  doctor  are  but  small  parts  of  her  work,  and 
unless  the  workers  are  sure  that  they  will  be  able  to  see  the 
nurse  without  the  presence  of  a  third  person,  she  will  lose 
her  most  valuable  opportunities  to  aid  the  workers,  the 
doctor  and  the  employer. 

A  small  surgical  dressing  room  will  also  be  required,  and  a 
room  adjoining,  where  dressings  which  might  embarrass  the 

51 


52  INDUSTRIAL  NURSING 

patient  may  be  done,  is  convenient.  If  space  is  limited,  the 
nurse's  office  might  be  used  for  such  work.  Beds  or  couches 
are  needed  and  they  are  often  placed  in  the  dressing  room, 
a  bad  arrangement  where  the  work  is  at  all  heavy.  Patients 
who  need  to  lie  down  should  be  quiet,  and  this  is  impossible 
if  no  special  rest  room  is  provided.  Even  though  the  waiting 
room  must  be  sacrificed,  patients  waiting  in  the  hall,  an 
effort  should  be  made  to  set  aside  one  room  for  rest  and  quiet. 
Two  rest  rooms,  one  for  men  and  one  for  women,  are  desir- 
able. In  order  that  any  seriously  injured  person  may  be  sent 
away  without  confusion,  a  separate  screened  exit  with  a 
drive  for  an  ambulance  is  a  convenience.  A  clothes  closet 
and  locked  cabinets  for  records  should  not  be  forgotten. 
A  small  cabinet  in  the  dressing  room  may  be  used  for  open 
cases,  the  cards  being  transferred  to  large  cabinets  in  the 
nurse's  office. 

It  is  true  that  the  nurse  must  often  manage  with  one  room 
and  may  possibly  need  no  more  space,  but,  as  four  rooms 
and  a  waiting  room  are  so  desh-able  and  suit  the  needs  of 
so  many  plants,  the  fitting  up  of  such  a  place  will  be  con- 
sidered. 

If  the  plant  spreads  over  much  ground,  several  first  aid 
stations  may  be  required.  In  any  case,  but  one  main  station 
with  four  rooms  will  be  used,  unless  in  a  very  large  plant  with 
many  nurses.  The  centralization  of  work,  records  and  sup- 
phes  in  the  main  first  aid  room  means  economy  of  time,  labor 
and  expense.  If  found  absolutely  necessary  others  may  be 
opened  in  remote  parts  of  the  plant.  These  outljdng  stations 
should  be  as  simple  as  will  suffice  for  the  needs  of  the  part 
of  the  plant  which  they  are  to  serve. 

A  nurse,  working  without  assistants,  must  branch  out  care- 
fully lest  she  find  herself  with  more  than  she  can  properly 
supervise.  Often  the  staff  must  grow  before  the  work  can 
be  increased.  By  slow  development,  reconstruction  and  un- 
necessary building  may  be  avoided. 

In  one  plant  there  is  a  large  station,  such  as  has  been  de- 
scribed, and  a  smaller  room  at  the  other  end  of  the  grounds,  A 


THE  FIRST  AID  ROOM  53 

clerk,  who  has  been  trained  in  the  simplest  first  aid  methods, 
spends  her  time  in  the  larger  station,  keeping  all  the  records 
for  both  rooms,  attending  to  the  supplies  and  sometimes 
giving  first  aid  when  the  nurse  is  in  another  part  of  the  plant. 
At  the  other  station,  a  worker  near  by  keeps  the  key,  knows 
how  to  give  very  simple  first  aid  and  is  able  to  stay  with  the 
patient  until  the  nurse  can  be  summoned.  The  nurse  can 
always  be  reached  by  telephone.  She  spends  her  mornings 
and  noon  hours  in  the  main  station  and  goes  to  the  other 
room  when  needed.    She  is  provided  with  an  automobile. 

Another  plant  has  a  large  station,  where  the  greater  part  of 
the  work  is  done  and  where  records  and  supplies  are  kept, 
and  twelve  smaller  rooms  in  different  parts  of  the  plant, 
each  in  the  care  of  a  near  by  worker  who  has  been  trained  in 
first  aid.  The  nurse  is  consulted  by  telephone  when  her 
advice  is  needed.  She  \^sits  the  rooms  for  inspection  at 
regular  intervals  and  in  case  of  serious  injury  but,  whenever 
possible,  injured  workers  are  sent  to  the  main  station. 

Often  small  cabinets  with  first  aid  materials  are  placed 
with  responsible  persons  through  the  plant.  It  is  easy  to 
carry  this  too  far,  thus  defeating  the  purpose  of  the  first 
aid  organization,  which  is  to  give  each  injury,  no  matter  how 
small,  the  protection  of  skilled  nursing  care.  Supplementary 
first  aid  stations  are  useful  in  providing  a  place  for  an  injured 
worker  to  rest  while  help  is  being  summoned  and  in  making 
available  a  supply  of  sterile  dressings  with  which  wounds 
may  be  covered  while  the  patient  goes  to  the  doctor  or  to  the 
nurse. 

In  connection  with  the  future  growth  of  the  main  first 
aid  station,  the  nurse  may  give  thought  to  some  or  all  of  the 
following  lines  of  progress: — Rest  rooms  for  all  workers  for 
the  noon  hour,  lunch  rooms,  roof  garden,  recreation  hall, 
circulatmg  library,  drying  rooms  for  wet  clothes,  wash 
rooms,  baths,  counters  for  the  loan  or  sale  of  umbrellas, 
rubbers,  stockings,  dry  skirts,  and  in  the  food  trades  espe- 
cially, a  manicure  service  and  freshly  laundered  uniforms  for 
the  workers. 


54  INDUSTRIAL  NURSING 

If  the  industrial  doctor  spends  his  entire  time  in  the  plant, 
the  extension  of  the  work  often  demands  space  for  X-ray- 
rooms,  laboratories,  offices  for  various  specialists,  and  for 
dentist  and  chiropodist  in  addition  to  the  doctor's  own  of- 
fices. Where  there  is  such  a  medical  department  the  planning 
will  of  course  be  done  by  the  industrial  physician.  In  any 
case  the  nurse  will  do  her  work  more  efficiently  if  she  has 
in  addition  to  the  equipment  at  hand,  her  own  private  office, 
no  matter  how  small. 

However  conspicuous  the  site  for  the  first  aid  room  may- 
be, a  number  of  signs  and  pointing  arrows  will  be  needed 
to  make  plain  where  the  place  is  and  what  it  is  for. 

In  planning  the  partition  of  the  space  allowed,  care  should 
be  exercised  that  beds  and  stretchers  may  be  easily  moved 
where  needed,  that  doors  are  wide  enough  and  that  narrow 
stairs  and  sharp  turns  do  not  make  it  difficult  to  move  an 
injured  person.  If  it  is  possible  to  have  all  partitions  extend 
to  the  ceiling,  much  daily  labor  of  dusting  will  be  saved. 
Careful  cleaners  for  such  work  are  hard  to  find,  and  add  to 
the  expense  of  the  department.  A  little  additional  cost  in 
providing  smooth  doors  and  walls  and  in  avoiding  dirt- 
catching  corners  and  ledges  will  be  repaid  in  subsequent 
saving  of  labor.  The  standards  of  cleanliness  in  the  most 
sanitary  factories  are  seldom  those  of  a  hospital,  and  some 
men  are  apt  to  think  a  nurse  unduly  particular.  Care  in  plan- 
ning will  save  much  difficulty  later  on  in  keeping  the  first  aid 
room  in  proper  condition. 

Plumbing: — The  minimum  amount  of  plumbing  for  a  first 
aid  room  should  include  an  abundant  supply  of  hot  and  cold 
water,  a  large  stationary  sink  or  basin  and  a  toilet.  A  slop 
sink  should  be  provided  unless  there  is  one  near  by.  In 
addition,  a  small  stationary  hand  basin  in  the  toilet  room 
and  a  stationary  foot  tub  which  may  be  screened  off  are  almost 
necessities  where  much  work  is  to  be  done.  A  bath  tub 
and  a  shower  are  greatly  appreciated  conveniences.  A 
pressure  sterilizer  will  save  large  sums  in  the  purchase  of 
sterile  dressings  and  will  eventually  pay  for  itself  unless  con- 


THE  FIRST  AID  ROOM  55 

venient,  economical  arrangements  can  be  made  with  a  hos- 
pital for  the  sterilization  of  supplies.  Live  steam  which  is 
usually  available  in  manufacturing  plants  can  be  utilized 
for  the  sterilizer.  Gas,  oil,  alcohol  or  electricity  may  be  sub- 
stituted, but  all  require  careful  watching,  which  is  often  im- 
possible when  one  nurse  is  responsible  for  the  first  aid  in  a 
large  plant. 

Walls  and  Floors: — While  tiling  is  the  ideal  wall  and  floor 
material,  the  expense  is  often  prohibitive.  A  hard  maple 
floor  scrubbed  daily  c;  a  battle-ship  linoleum  cemented 
down  will  answer  if  care  is  taken  that  joinings  fit  tightly  and 
that  there  are  no  crevices  at  the  3'^'ges  for  the  accumulation 
of  dirt.  The  walls  may  be  painted  with  a  hard-finish,  wash- 
able paint.  An  oilcloth  covering  is  manufactured  for  walls 
which  lasts  well  and  is  easily  washed.  It  should  have  careful 
fitting  for,  unless  well  applied,  it  frequently  becomes  loose 
at  edges  and  corners.  As  white  is  trying  to  eyes,  buff  o." 
French  gray  color  will  prove  restful.  If  the  light  is  poor, 
white  may  be  bettt". 

Even  though  an  unsuitable  corner  must  frequently  be  used 
for  the  nurse's  headquarters,  no  effort  should  be  spared  to 
mrke  it,  as  far  as  possible,  an  example  cf  cleanHness  and  neat- 
ness. 

Decorations: — Decorations  seem  out  of  place  in  a  first 
aid  room.  A  few  clean,  thrifty  plants  will  make  the  rooms 
as  attractive  as  though  elaborately  provided  with  pictures, 
hangings  and  rugs. 

Furniture: — The  number  of  workers,  men  and  women, 
and  the  hazards  of  the  industry,  as  well  as  the  space  avail- 
able, will  determine  the  quantity  of  furniture  required.  In 
a  single  room,  a  writing  table,  a  cupboard,  two  stools  (one 
high  and  the  other  of  chair  height),  a  dressing  table,  two 
chairs  and  a  couch  may  be  all  for  which  there  is  space  or 
need. 

The  furnishing  of  the  group  of  four  rooms,  already  de- 
scribed, will  be  considared.  The  lists  following  have  been 
found    satisfactory    in    industries    accompanied    by    minor 


56  INDUSTRIAL  NURSING 

hazards  and  employing  from  five  to  eight  thousand  workers, 
with  industrial  physicians  doing  most  of  their  work  in  their 
private  offices  but  coming  to  the  plant  in  case  of  serious  in- 
jury. 

For  the  waiting  room,  chairs  or  benches  may  be  chosen. 
Benches  fastened  to  the  floor  are  thought  less  noisy  and  may 
be  less  expensive. 

The  nurse's  office  should  have  a  desk  and  two  chairs  and 
the  required  filing  cabinets.  A  clothes  closet  should  be  in 
or  near  the  office. 

The  dressing  room  should  be  furnished  with  a  writing 
table,  a  glass  covered  dressing  table,  a  stool  of  chair  height,  a 
high  stool,  two  chairs  and  a  wall  cabinet  with  shelves. 

A  two-burner  gas  plate  is  less  expensive  and  more  practical 
than  a  regular  instrument  sterilizer.  It  should  be  placed  on  a 
metal  and  asbestos-covered  shelf  of  convenient  height  and 
the  wall  behind  should  be  protected  in  like  manner.  As 
matches  may  not  legally  be  kept  in  factories  in  some  states, 
patent  friction  lighters  should  be  provided.  Unless  a  doctor 
spends  his  whole  time  in  the  plant,  such  a  stove  is  all  that  is 
needed  for  the  preparation  of  sterile  water  and  solutions  and 
for  the  boiling  of  instruments  and  utensils. 

One  of  the  stationary  wash  basins  should  be  placed  in  this 
room  and,  if  possible,  set  so  that  the  nurse  can  stand  between 
it  and  the  dressing  table,  the  table  being  on  her  right  and  the 
basin  on  her  left.  She  will  then  be  able  to  wash  her  hands 
when  necessary  without  stepping  from  her  work.  When  one 
nurse  must  often  bandage  fifty  or  sixty  fingers  in  a  short 
time,  no  saving  of  time  or  strength  is  too  small  to  be  con- 
sidered, if  she  is  to  have  time  for  any  of  the  other  work 
which  should  be  done. 

For  the  rest  room,  many  firms  provide  low  wicker  couches 
with  pillow  and  blanket.  These  are  comfortable  when 
workers  are  allowed  to  rest  in  the  room  but  are  not  suitable 
for  the  care  of  injured  or  sick  persons  even  for  a  short  time. 
Two  hospital  beds  of  proper  height  and  provided  with 
mattresses,  pillows,  sheets,  pillow  covers  and  blankets  add 


THE  FIRST  AID  ROOM  57 

greatly  to  the  comfort  of  both  patient  and  nurse  and  will  be 
used  daily  in  any  large  plant.  AVhere  economy  of  space  need 
not  be  considered,  two  rest  rooms  or  even  three  are  sometimes 
provided.  One  room  is  furnished  with  couches  for  women 
who  need  only  rest,  one  is  provided  with  beds  for  the  sick  or 
injured  women  workers  and  another  for  men.  The  rest  room 
with  couches  might  well  be  for  the  use  of  women  wishing  to 
rest  during  the  noon  hour.  Men  usually  scorn  a  couch  unless 
sick  enough  to  require  care.  One  room  is  often  made  to  serve 
for  both  men  and  women  by  the  use  of  screens.  If  one  of  each 
sex  is  injured  at  the  same  time,  it  is  usually  easy  to  send  the 
one  less  seriously  injured  to  his  home  or  elsewhere. 

If  expense  need  not  be  too  carefully  considered,  the  regula- 
tion, white  enameled  hospital  furniture  is  usually  purchased. 
However,  a  large  sum  need  not  be  expended.  Many  large 
plants  maintain  carpenter,  glazier  and  paint  shops.  Often 
articles  can  be  made  and  painted  in  the  plant.  Kitchen 
chairs  and  tables  and  cheap  office  stools,  painted  white,  look 
well  and  are  easily  cleaned  and  re  finished.  A  search  through 
the  plant  will  sometimes  reveal  discarded  furnishings  which, 
when  painted,  are  more  convenient  than  any  that  could  be 
purchased.  A  kitchen  table  painted  and  provided  with  a 
glass  top  answers  for  a  dressing  table.  A  large  bathroom 
cabinet  will  take  the  place  of  an  expensive  one  from  a  surgical 
supply  house.  A  four-leaf  clothes  horse,  painted  white  and 
provided  with  heavy  mushn  covers  tied  on  with  tapes,  makes 
a  neat  and  useful  screen.  A  small  pine  stand  will  make  a 
good  bedside  table.  French  gray  paint  is  attractive  for  all 
except  the  dressing  room  furniture. 

In  planning  the  furnishings  three  lists  will  make  plain  to 
the  management  the  relative  advantages  of  each  class  of 
articles.  One  Ust  should  be  of  regulation  hospital  furnish- 
ings, the  second  of  cheaper  substitutes  and  the  third,  of  those 
articles  which  could  be  made  in  the  plant.  The  first  two 
lists  should  contain  the  approximate  cost  of  each  article  and 
when  submitted  to  the  head  of  the  carpenter  and  paint  shops 
he  will  be  able  to  quote  the  comparative  costs  of  home-made 


68  INDUSTRIAL  NURSING 

articles.  The  three  Hsts  may  then  be  submitted  to  the  person 
having  charge  of  the  purchasing  department,  or  to  the  man- 
ager, for  decision.  Sometimes  the  nurse  is  asked  to  do  the 
buying  and  in  other  plants,  a  certain  sum  may  be  placed  at 
her  disposal  and  as  long  as  she  does  not  exceed  her  budget, 
she  is  free  to  use  her  own  judgment.  In  any  case  a  knowledge 
of  cost  is  valuable  and  is  easily  acquired  from  catalogues. 
No  prices  are  given  here  as  conditions  change  so  rapidly  that 
they  would  be  of  no  permanent  value. 

Shades  and  Curtains: — Few  hangings  of  any  sort  are  needed 
and  they  should  be  avoided  wherever  possible.  Straight 
muslin  curtains  are  attractive  if  frequently  laundered,  and 
protect  the  rooms  from  prying  eyes.  Shades  may  be  neces- 
sary for  this  purpose  and  as  a  protection  fiom  direct  sunlight. 
Dark  shades  are  advisable  in  the  rest  room  and,  if  an  eye 
specialist  attends  paticvits  in  the  plant,  a  way  of  darkening 
the  room  in  which  he  works  should  be  jr-rovided.  A  regularly 
attending  oculist  would,  of  course,  plan  his  own  quarters. 
Shades  should  be  of  glazed  holland  or  similar  material 
and  should  be  taken  out  of  doors  and  dusted  at  regular 
intervals. 

Utensils: — Bowls,  basins,  trays,  etc.,  may  be  of  white 
enamel,  earthenware  or  glass.  If  handled  carefully,  earthen- 
ware or  glass  last  longer  than  enamel.  A  good  supply  of 
small  utensils  is  an  economy  of  time  where  the  work  is  at  all 
active.  Fingers  may  be  put  to  soak  while  patients  are  wait- 
ing, and  freshly  steriHzed  bowls  may  be  kept  ready  in  suffi- 
cient numbers. 

The  following  list  of  utensils  has  been  found  ample  for  a 
very  busy  first  aid  room. 

2  teakettles,  one  for  hot  and  one  for  cold  sterile  water. 

1  large  fish  kettle  for  sterilizing  small  utensils  and  for  the 
surgeon's  instruments. 

1  small  covered  basin  with  a  handle  and  wide  enough  to 
hold  the  nurse's  instruments. 

1  pitcher  (2  qt.)  for  mixing  solutions,  etc. 

1  pitcher  (1  pt.). 


THE  FIRST  AID  ROOM  59 

2  hand  basins. 
6  bowls  (1  pt.). 

3  bowls  (4  qt.). 

1  covered  jar  for  dressings. 

1  covered  jar  for  sponging  cotton. 

1  irrigating  can  and  tube. 

1  mug  (3^2  pt-)  for  keeping  the  points  of  fresh  instruments 
sterile  in  solution. 

1  mug  (3^  pt.)  of  another  color  or  shape  for  used  instru- 
ments. 

1  measuring  glass  (500  cc). 
6  small  medicine  glasses. 

6  tumblers. 
6  spoons. 

2  clinical  thermometers. 

1  thermometer  for  testing  solutions. 

3  cups,  plates  and  spoons.    A  sick  or  injured  person  is  often 

benefited  by  a  small  lunch.  Food  is  not  a  common 
first  aid  room  need  but  it  should  be  possible  to  give  a 
little  nourishment,  when  that  is  what  the  patient 
needs.^ 

2  trays  for  carrying  dressings  to  the  rest  room. 
Instruments: — Few  instruments  are  needed  by  a  nurse.    If 

cases  requiring  surgical  care  are  treated  in  the  doctor's 
private  office  or  sent  to  a  hospital,  the  only  instruments  re- 
quired are  for  handling  gauze,  removing  splinters  and  for 
carrying  out  the  doctor's  orders  in  the  cases  which  he  sends 
for  redressings,  possibly  a  probe  and  a  grooved  director  for 
inserting  drains  under  the  orders  of  the  surgeon.  If  the 
doctor  does  actual  surgical  work  in  the  first  aid  room,  he  will 
order  his  own  instruments  and  the  nurse  should  keep  them 
apart  and  allow  them  to  be  used  by  no  one  else.    A  good 

'  Where  there  is  no  lunch  room  in  the  plant,  a  little  coffee,  malted 
milk,  a  can  of  evaporated  milk  and  a  few  crackers,  purchased  by  the 
nurse,  will  make  it  possible  for  her  to  make  an  occasional  patient  feel 
that  he  has  been  looked  after  in  every  way.  A  worker  who  has  eaten 
no  lunch  should  not  be  sent  home  after  even  a  sHght  injury  if  he  is 
faint  and  hungry. 


60  INDUSTRIAL  NURSING 

supply  of  forceps  and  scissors  should  be  at  hand  in  a  large 
plant.  In  some  small  plants  a  nurse  might  easily  manage  with 
one  instrument  of  each  kind. 

With  frequent  sterilizations,  the  following  list  will  answer 
for  a  first  aid  room  caring  for  from  fifty  to  a  hundred  dress- 
ings a  day: 

1  large  spatula. 

1  small  spatula. 

6  small,  straight,  pointed  scissors. 
6  small  dressing  forceps. 

2  splinter  forceps. 

3  probes  1  for  redressings  sent  to  the  nurse  by 
3  grooved  directors]       the  doctor. 

Drugs: — As  the  industrial  nurse,  working  often  without 
the  immediate  presence  of  the  doctor,  even  though  under  his 
directions,  may  be  subject  to  misunderstanding,  she  should 
protect  herself  from  unjust  criticism  by  limiting  her  suppHes 
so  that  it  is  quite  clear  she  cannot  possibly  take  upon  herself 
the  physician's  duties. 

Aside  from  supplies  specially  ordered  by  the  doctor,  the 
following  list  of  drugs  ^  has  been  found  ample  in  several  large 
plants. 

Boric  acid. 

Essence  of  peppermint. 

Jamaica  ginger. 

Aromatic  spirits  of  ammonia. 

Oil  of  cloves.    (Of  doubtful  utility.) 

White  wine  vinegar. 

Bicarbonate  of  soda. 

Castor  oil. 

Tincture  of  iodine  7%.  (To  be  diluted  to  3%  or  less  be- 
fore using. 

Alcohol. 

Bichloride  of  mercury  tablets.  (Not  an  absolute  neces- 
sity.) 

^  Alcoholic  stimulants  have  no  place  in  the  first  aid  room  unless  by 
the  express  wish  of  company  physician.    Coffee  should  be  available. 


THE  FIRST  AID  ROOM  61 

Colodion,  (For  use  in  sticking  down  rough  edges  of  finger 
dressings,  not  for  sealing  dressings  or  application  to 
wounds.) 

Benzene  or  gasoline.    (For  removing  plaster  from  the  skin.) 

Carbohzed  vasehne.  (For  chapped  or  rough  hands  which 
interfere  with  work.) 

Boric  acid  ointment  or  other  burn  ointment  in  large  quan- 
tity. 

Soda  bicarbonate  ointment  (3%). 

Some  cathartic  pills  or  fluids  are  usually  provided  with 
the  advice  of  the  doctor,  but  their  use  should  not  be  en- 
couraged. 

A  hypodermic  case  and  certain  stimulants  are  left  with  the 
nurse  by  some  doctors,  but  they  may  usually  be  dispensed 
with.  Unless  the  plant  is  at  some  distance  from  a  doctor 
external  heat  will  answer  in  most  cases  until  assistance  can  be 
summoned. 

Antidotes  to  any  poisons  used  in  the  industry  should  be  at 
hand.  An  emetic  or  a  tank  of  oxygen  may  sometimes  be 
needed.  The  doctor  should  assume  the  responsibility  for 
saying  what  drugs  should  be  at  hand,  except  home  remedies 
and  simple  antiseptics  and  disinfectants  which  might  be 
found  in  the  medicine  closet  of  any  careful  housewife. 

After  consultation  with  the  company  doctor,  provision 
must  often  be  made  for  the  treatment  of  pediculosis,  ring 
worm,  scabies,  etc.  Children  who  have  to  work  seldom  have 
homes  where  such  treatment  is  properly  carried  out.  They 
are  usually  sensitive  about  their  condition  and  a  nurse  will 
gain  their  confidence  best  by  quietly  helping  them.  When 
they  know  what  proper  treatment  is,  they  often  apply  what 
they  have  learned  in  the  treatment  of  the  whole  family. 

Dressings: — It  is  practically  impossible  to  purchase  sterile 
dressings  which  may  be  used  in  industrial  first  aid  rooms  with- 
out waste.  Gauze  should  be  purchased.  Bandages  are 
cheaper  when  bought  than  when  made  in  the  plant.  Sterile 
bandages  are  unnecessary,  and  the  plain  cut  gauze  bandages 
are  much  cheaper  and  serve  as  well  as  those  which  are  torn 


62  INDUSTRIAL  NURSING 

or  cut  to  thread  and  elaborately  wrapped  and  sterilized. 
Instead  of  absorbent  cotton,  by-products  may  sometimes  be 
utilized  in  the  textile  industries.  In  cotton  mills,  waste  may 
be  boiled  in  soda  and  well  rinsed  at  the  bleach  house,  then 
sterilized  in  the  first  aid  room  for  use  in  cleaning  wounds  and 
wherever  absorbent  cotton  would  be  used.  If  run  through  a 
carding  machine,  it  will  be  easy  to  handle,  very  absorbent 
and  will  look  nearly  as  well  as  the  cotton  manufactured  for 
surgical  use.  If  a  hundred  pounds  are  prepared  at  once,  the 
labor  is  very  little  and  the  supply  will  probably  last  several 
years.    Heavy  muslin  makes  good  dressing  covers. 

A  box  shop  is  a  convenience  found  in  many  plants.  Gauze 
may  be  cut  there.  This  means  a  great  saving  of  time  and  the 
product  is  perfectly  suited  to  first  aid  and  to  many  other 
dressings.  Two  sizes  are  useful,  two  inch  squares  and  four 
inch  squares.  The  smaller  size  is  just  right  for  finger  dress- 
ings and  many  other  uses  and  the  larger  size,  with  a  few 
yard  length  rolls,  some  half  yard  squares  and  cotton  will  be  all 
the  dressings  that  can  possibly  be  needed. 

Other  Medical  and  Surgical  Supplies: — In  addition  to  those 
already  mentioned,  a  well-equipped  first  aid  room  will  be 
supplied  with  the  following  articles: 

Splints  of  light  strong  board  for  leg,  arm  and  thigh. 

Bass  wood  splints,  wooden  tongue  depressors,  applicators 
and  tooth  picks. 

Paper  bags  or  newspaper  for  wiapping  soiled  aressings. 

A  sanitary  trash  can. 

Eye  cups. 

Medicine  droppers  with  red  bulbs. 

Medicine  droppers  with  white  bulbs. 

Tourniquet.  (In  plain  sight,  always  in  the  same  spot  and 
frequently  tested.) 

Sugar. 

Salt. 

6  fruit  jars  with  clamped  covers  for  drains,  swabs,  etc. 

('A  Pt.) 

Slings.     (May  be  made  of  cheap  unbleached  cheese  cloth.) 


THE  FIRST  AID  ROOM  63 

Adhesive  plaster.  (When  rolled  on  metal  spools  the  cost  is 
much  greater  than  when  protected  with  muslin  and  the 
latter  is  nearly  as  convenient.) 

Ice  bag. 

Hot  water  bag. 

Stomach   and   rectal   tubes. 

Stretcher.    (One  that  can  be  used  as  a  cot.) 

Hand  brushes. 

Pins  (straight  and  safety) .    Tied  bandages  are  an  economy. 

Platform  scales. 

Linen: — An  amount  of  linen  must  be  provided  according 
to  the  size  of  the  plant.  In  one  plant  with  from  five  to  eight 
thousand  employes,  where  the  laundry  was  done  weekly,  the 
following  was  an  ample  supply : 

3  dozen  sheets.    (Sheets  are  used  instead  of  bed  spreads.) 

2  dozen  pillow  cases. 

12  dozen  hemmed  huck  squares,  about  9  inches  square,  for 
hand  towels 

2  dozen  dressing  towels,  to  be  sterilized. 

2  washable  laundry  bags. 

1  blanket  for  each  bed  or  cot. 

Rubber  sheets  and  pillow  covers. 
Laundry  bags  of  ticking  1  yd.  by  IJ^  yd.  when  finished,  pro- 
vided with  a  slit  halfway  down  the  middle  of  the  front, 
four  large  metal  eyelets  in  the  upper  edge  matching  four 
hooks  on  toilet  or  bathroom  wall  near  a  window,  are  neat  and 
practical.  As  laundry  work  will  probably  be  sent  out  only 
once  a  week,  great  care  must  be  taken  as  to  the  condition 
of  articles  placed  in  the  bag.  Hotels  and  department  stores 
and  food  industries  usually  maintain  laundries,  and  textile 
mills  have  bleaching  rooms  where  soiled  dressings  and  towels 
may  sometimes  be  washed.  Dressings  to  be  burned  should 
be  sent  to  the  furnace  in  a  firm  bundle. 

Sometimes  necessary  sewing  may  be  done  in  a  sewing 
room  connected  with  the  plant.  Thread  mills  have  testing 
rooms  where  each  lot  of  thread  is  tried  on  sewing  machines 
and  where,  incidentally,  sewing  is  wanted.    Hotels,  depart- 


64  INDUSTRIAL  NURSING 

ment  stores  and  clothing  industries  have  people  to  do 
sewing.  A  nurse's  thoughtfulness  in  finding  out  how  she 
can  use  what  is  at  hand  in  the  way  of  such  help  will  usually 
be  appreciated. 

In  fitting  up  the  smaller  first  aid  stations,  the  equipment 
should  be  simple  and  fitted  only  to  the  needs  of  the  par- 
ticular part  of  the  plant  to  be  served.  A  careful  study  of  the 
hazards  wiU  show  that  suitable  forceps  are  needed  when 
workers  may  have  splinters  or  needles  break  off  in  their 
fingers;  where  poisons  are  used  in  the  plant  there  should  be 
antidotes  at  hand,  and  some  one  on  the  spot  should  know 
what  to  do  in  case  of  injury.  (Chemists  are  employed 
in  many  industries  and  they  sometimes  have  this  matter 
in  hand.)  Other  needs  should  be  considered,  such  as  poison- 
ous gases,  electric  currents,  caustic  alkaU  and  acid  which 
may  cause  burns,  particularly  eye  burns.  The  industrial 
doctor  must  be  consulted  until  all  these  danger  points  have 
been  covered. 

It  is  impossible  to  describe  all  the  hazards  in  industry. 
Employers  and  state  and  federal  departments  and  safety 
organizations  are  working  for  the  decrease  of  danger.  But 
it  can  never  be  entirely  abolished.  When  the  machinery 
is  as  safe  as  it  can  be  made  employes  still  cause  injury 
to  themselves  and  to  others  by  carelessness  or  blun- 
dering. 

In  keeping  the  smaller  first  aid  rooms  supphed  with  the 
necessary  articles,  a  system  of  regular  inspection  is  essential, 
or  supplies  will  disappear  or  be  tucked  away  and  not  be  found 
when  wanted.  Some  one  person  must  be  held  responsible 
for  the  condition  of  each  station.  A  hst  of  articles  with  the 
places  in  which  they  are  to  be  kept  will  aid  both  inspector 
and  the  person  responsible.  The  following  list  has  been  used 
in  supplementary  first  aid  rooms  where  the  needs  were  of  a 
general  nature: 

Tojp  >S/ieZ/.-— Splints. 
Paper  bags  or  newspapers  (for  wrapping  soiled  dress- 
ings.) 


THE  FIRST  AID  ROOM 


65 


In 


original 
covers. 


muslin 


1st  Shelf  from  Top: — 
Jar  of  cotton, 

3  packages  of  sterile  gauze  (2  in.) 
3        "  "      "         "      (4  in.) 

3roUs  "      "         "      (1yd.) 

1  package      "      "    swabs  (small) 
1  eye  cup. 

1  eye  dropper  with  wbite  bulb,  boiled  and  in  boric  solu- 
tion. 

Boric  acid  solution. 

Tourniquet,  extreme  right  in  plain  sight. 
Snd  Shelf  from  Top:— 

Cup  and  saucer,  spoon. 

Sugar.     (May  be  omitted.) 

Salt. 

Essence  of  peppermint. 

Jamaica  ginger. 

Aromatic  spirits  of  ammonia.     (Rubber  cork.) 

Oil  of  cloves.     (May  be  omitted.) 

White  wine  vinegar. 

Castor  oil.    (Sterilize  after  using  and  seal  for  next  time.) 

Small  measuring  glass. 
Srd  Shelf  from  Top:— 

Tooth  picks  in  covered  jar, 

2  slings. 

Adhesive  plaster. 
Spatula  (small) 
Scissors 

Dressing  forceps 
Splinter  forceps 
Large  needle 

!6  one-inch. 
6  three-inch. 
3  four-inch. 
Bottom  shelf: — 

Tincture  of  iodine,  2%  to  3%.     (Tight  rubber  cork.) 
Medicine  dropper  with  red  rubber  bulb. 


Sterile  and  in  original  wrapper. 


66  INDUSTRIAL  NURSING 

Benzene. 

Carbolized  vaseline.    (For  rough  hands,  not  for  wounds.) 
Alcohol. 

Boric  acid  ointment  or  other  burn  ointment. 
Other  articles: — 
Towels. 

Ice  bag  on  proper  hook. 
Hot-water  bag  on  proper  hook. 
Cotton  for  padding  splints,  etc. 
2  sheets. 
2  pillow  covers 
Blanket. 
Stretcher. 
2  hand  brushes. 

1  hand  basin. 

2  bowls  (small) 
1  mug. 

Books  for  Reference,  etc.: — For  convenience  a  few  reference 
books  should  find  a  place  in  the  nurse's  office.  A  directory 
of  the  plant  containing  a  list  of  department  heads,  foremen, 
and  other  persons  in  authority  with  their  telephone  numbers, 
and  in  a  large  plant,  a  map  of  the  premises  will  be  required. 
A  telephone  directory  and  a  street  directory  with  a  map 
of  the  town  and  a  purchased  or  home-made  directory  of 
local  social  agencies,  are  essential. 

A  small  professional  library  will  be  frequently  consulted. 
Such  books  are  often  owned  by  the  nurse  and  she  will  of 
course  wish  to  possess  what  she  needs  for  her  own  personal 
information  and  development.  A  work  on  industrial  diseases, 
one  or  more  books  on  first  aid,  especially  with  reference  to 
methods  of  teaching  the  subject  to  laymen,  bulletins  of  local, 
state  and  federal  health  and  labor  departments,  especially 
those  which  treat  of  the  health  and  accident  hazards  of  the 
particular  industry,  a  small  manual  of  materia  medica,  a 
medical  dictionary,  will  all  be  found  useful  and  the  list  will 
be  increased  by  any  industrial  nurse  who  gets  a  vision  of 
her  opportunities  and  prepares  herself  to  grasp  them. 


THE  FIRST  AID  ROOM  67 

A  few  elementary  books  on  personal  hygiene,  practical 
dietetics,  child  care,  first  aid  in  the  home  and  kindred  sub- 
jects, if  provided  by  the  company,  may  be  profitably  used 
as  a  loan  library.  Workers  may  be  interested,  while  a  dressing 
is  being  done  or  other  service  rendered,  and  will  often  be  glad 
to  read  a  practical  book  on  the  subject  of  their  needs. 

The  nurse's  office  also  seems  the  logical  place  for  the  nurse's 
own  professional  periodicals.  The  Survey,  The  Public 
Health  Nurse,  and  trade  journals  dealing  with  questions  of 
sanitation  and  safety. 

There  will  be  little  time  for  real  reading  but  points  may  be 
looked  up  when  necessary,  the  journals  may  be  taken  on 
necessary  car  trips  and  the  total  value  will  amount  to  an 
appreciable  sum. 

Economy  in  the  Use  of  Supplies  and  in  other  Expenditures: 
For  her  own  self-respect  and  for  the  example  she  imconsciously 
sets  for  those  who  watch  her  work,  if  for  no  other  reasons, 
the  industrial  nurse  will  employ  every  means  possible  in  the 
economical  use  of  supplies  and  in  keeping  the  expenses  of 
her  department  at  the  lowest  point  consistent  with  efficiency. 
Most  firms,  even  though  liberal  in  providing  not  only  what 
is  needed  but  all  that  is  desirable,  keep  careful  account  of  the 
actual  cost  of  each  department  and  the  amount  of  overhead 
charge  of  each^  compare  these  costs  from  year  to  year,  con- 
sider the  work  lone,  and  the  results  accomplished.  The  total 
cost  of  the  work  is  also  divided  by  the  number  of  employes, 
thus  showing  the  averajre  cost  per  worker.  Such  figures  are 
often  exchanged  by  employers  who  take  great  interest  in 
comparing  co:?ts  and  results.  Of  course  many  of  the  nurse's 
best  result?  are  intangible,  buc  many  of  them  are  reduced  to 
black  and  white  in  statistical  departments.  The  systems 
of  statistics  differ  in  different  plants  so  that  estimates  of 
the  cort  of  vary  similar  service  have  been  seen  varying  from 
$.50  to  S2.50  and  even  $5.00  per  year  per  employe.  Of  course 
in  small  planes  the  cost  is  relatively  more  than  in  larger  ones. 
One  of  the  reasons  that  many  small  employers  give  for  not 
establishing  industrial  nursing  is  that  they  cannot  afford  it. 


68  INDUSTRIAL  NURSING 

It  would  seem  that  industrial  nurses  should  be  able  to  show, 
from  their  uniform  results  and  by  their  uniform  methods, 
that  no  employer  can  afford  to  do  without  industrial  nurs- 
ing. 

Labor  organizations  and  industrial  relief  associations  are 
appreciating  the  value  of  industrial  nursing  both  in  the  homes 
and  in  the  plants  and  should  show  an  increasing  interest 
where  it  is  known  that  industrial  nurses  are  conservative 
in  expenditures,  as  well  as  efficient  in  the  prevention  and  relief 
of  injury  and  illness. 

Personnel: — Except  in  small  plants  or  in  those  in  which  the 
duties  required  of  the  nurse  are  of  a  very  limited  nature,  she 
will  require  some  assistance  from  the  very  first.  An  intelligent 
young  girl,  who  can  be  trained  to  do  clerical  work  and  taught 
the  simplest  first  aid,  will  be  able  to  keep  the  records,  see  to 
the  general  order  of  the  station,  assist  with  dressings  and 
attend  to  the  preparation  and  sterilization  of  supplies.  She 
should  be  a  person  of  some  refinement  and  dignity  as  she 
will  sometimes  be  alone  and  must  be  able  to  meet  the  workers 
in  a  pleasant  way,  but  without  encouraging  unpleasant  fa- 
miliarity. 

With  the  help  of  one  clerk,  the  nurse  should  organize  an 
efficient  first  aid  service  and  establish  a  system  of  records, 
possibly  doing  a  little  home  visiting,  but  surely  learning  the 
needs  of  the  plant  so  as  to  be  ready  to  meet  them  if  she  is 
given  the  opportunity. 

A  nurse's  time  is  too  valuable  to  be  used  in  keeping  simple 
records  and  in  much  of  the  other  work  which  might  as  well 
be  done  by  an  untrained  person.  Where  the  workers  are  en- 
tirely men,  these  duties  are  sometimes  assigned  to  a  young 
man,  but  in  most  plants  a  woman  or  girl  of  the  right  type  will 
be  more  satisfactory,  will  show  more  interest  and  will  be  less 
given  to  "skylarking." 

A  good  deal  of  development  and  extension  of  work  will  be 
possible,  without  additional  help,  as  the  industrial  nurse 
becomes  accustomed  to  her  duties  and  surroundings. 

The  further  increase  of  the  nurse's  staff  will  depend  en- 


THE  FIRST  AID  ROOM  69 

tirely  on  the  wishes  of  the  employer,  the  other  welfare  ac- 
tivities in  the  plant  and  on  the  ability  and  vision  of  the  nurse 
herself.  She  may  have,  eventually,  other  nurses,  additional 
clerks,  a  matron  for  the  rest  rooms,  a  lunch  room  force  and 
others  on  her  staff,  but  she  may  be  sure  that  such  growth 
will  seldom  be  possible  unless  the  financial  advantage  of 
each  step  is  clearly  appreciated. 


CHAPTER  VIII 

THE    VISITING   NURSE   IN   INDUSTRY 

The  visiting  nurse  in  industry  is  a  logical  development 
following  the  needs  discovered  by  the  industrial  nurse  in  the 
first  aid  room. 

An  employ^  suffers  an  industrial  injury  and  may  not  re- 
turn to  the  doctor  for  redressing  or  to  his  work  when  he  has 
recovered.  The  first  aid  nurse  will  be  asked  to  look  him  up. 
She  may  see  that  he  goes  to  the  doctor.  She  may  find  that 
he  is  not  able  to  do  so  and  that  she  must  ask  the  doctor  to 
visit  him.  If  he  has  recovered,  she  may  find  that  he  has  gone 
to  work  elsewhere. 

A  patient  is  sent  to  the  hospital  from  the  plant.  Report 
may  come  that  he  insists  on  going  home,  even  though  this 
will  be  dangerous.  A  visit  from  the  nurse  may  show  that 
she  can  easily  relieve  his  mind  about  conditions  at  home  or, 
if  he  is  not  satisfied  in  the  hospital,  she  may  be  able  to  ex- 
plain conditions  to  him,  or  even  have  them  adjusted  so  that 
he  becomes  comfortable  and  contented. 

A  sick  worker  may  be  sent  home  from  the  plant  and  the 
nurse,  not  being  sure  of  home  surroundmgs,  may  consider 
it  her  duty  to  make  a  visit,  even  going  on  a  holiday  if  she 
can  find  no  other  time. 

The  employer  may  ask  to  have  pensioners  visited.  The 
mutual  benefit  association,  though  not  employing  the  nurse, 
may  request  visits  to  those  claiming  benefit. 

The  employment  department  or  heads  of  other  depart- 
ments may  ask  to  have  absent  workers  looked  up.  The 
nurse  on  her  visit  may  find  a  sick  person  needing  care  and  not 
knowing  how  to  get  it.  She  may  discover  a  worker  obliged 
to  stay  at  home  with  a  sick  wife.    She  may  find  one,  as  the 

70 


THE  VISITING  NURSE  IN  INDUSTRY         71 

writer  did,  who  has  lost  his  pay  envelope  and  has  no  money 
for  car  fare. 

The  home  visiting  specially  requested  will  increase  as  it 
is  found  that  the  nurse  is  able  to  be  of  real  assistance. 

Unless  in  a  very  smaU  plant,  the  need  of  an  assistant  nurse 
will  soon  be  evident.  In  many  communities  an  automobile 
will  enable  one  nurse  to  make  fifty  to  seventy-five  per  cent 
more  calls.  As  the  nurse  finds  her  way  more  and  more  into 
the  homes,  innumerable  questions  appear,  in  the  solution  of 
which  she  can  be  of  more  general  help  than  a  home  visitor 
of  anj^  other  training  whatever. 

Without  intruding  her  presence,  without  much  added 
expenditure  of  time  and  almost  without  realizing  it  she  will 
be  compelled,  in  addition  to  the  definitely  requested  work, 
to  enter  more  or  less  into  the  field  of  general  public  health 
nursing.  Home  conditions  so  closely  affect  the  efficiency  of 
the  worker,  and  the  work  of  the  nurse  is  so  valuable  in  chang- 
ing these  conditions  for  the  better,  that  a  hard  and  fast  line 
between  industrial  and  other  visiting  nursing  is  impossible. 

Employers  see  that  they  must  do  something  towards 
making  our  masses  of  foreign  laborers  into  good  American 
citizens.  This  can  best  be  done  through  the  homes  and  the 
schools  and  no  one  can  enter  the  homes  so  naturally,  serve 
them  so  well,  or  make  herself  so  welcome  as  the  industrial 
visiting  nurse. 

With  a  knowledge  of  the  background,  habits  and  super- 
stitions of  the  workers  in  their  homelands  and  a  clear  insight 
into  the  essentials  of  wholesome  American  family  life,  the 
visiting  nurse  is,  according  to  the  statements  of  many  em- 
ployers and  others  in  a  position  to  know,  the  most  efficient 
single  agent  in  the  making  of  American  citizens  and  in  the 
promotion  of  mutual  understanding  in  industrial  relations. 
The  industrial  visiting  nurse  serves  the  employe  while  serving 
the  employer  in  ways  too  many  to  enumerate. 

Reaching  the  home,  as  she  often  does,  before  serious  illness 
has  appeared,  and  while  the  family  life  is  at  its  normal  state, 
she  has  a  better  opportunity  than  any  other  social  worker 


72  INDUSTRIAL  NURSING 

for  assisting  in  maintaining  or  developing  a  home  life  where 
provision  is  made  for  the  needs  of  normal  existence;  for 
health,  education,  employment,  recreation  and  moral  and 
spiritual  inspiration. 

By  her  friendship  with  people  of  many  races,  she  learns  the 
good  in  the  life  and  habits  of  each  and  can  assist  in  preserv- 
ing, from  other  civilizations,  much  that  should  make  our  own 
richer.  One  of  the  surest  ways  of  keeping  a  family  of  foreign 
birth  united,  happy  and  prosperous  in  the  freedom  of  our 
republic  is  to  impress  the  young  people  with  the  wisdom  and 
good  sense  of  their  parents.  The  schools  sometimes  make  an 
effort  to  do  this,  but  their  opportunities  are  not  those  of  the 
nurse  who  understands  the  parents  and  is  often  able  to  per- 
suade them  to  adopt  the  good  in  our  life  without  entirely 
changing  customs  to  which  they  cling. 

Industrial  efficiency  depends  so  closely  on  a  healthy  happy 
home  life  that  employers  often  send  visiting  nurses  into  the 
homes  in  order  that  regular  instructive  visiting  nursing  may 
be  done  as  well  as  following  up  into  the  homes  affairs  which 
have  had  their  origin  in  the  plant. 

There  seem  to  be  two  general  plans  for  the  organization 
of  visiting  nursing  service  by  industry.  One  is  often  employed 
in  a  small  or  backward  community  and  the  other  in  a  large 
progressive  town  already  supporting  many  social  agencies. 

In  the  former  case,  the  employer  may,  through  the  serv- 
ices made  available  to  his  force,  seek  to  foster  and  develop 
a  sense  of  civic  responsibihty  on  the  part  of  the  community. 
Through  the  industrial  visiting  nurse's  care  of  the  employes, 
a  demand  for  a  like  service  for  the  entire  population  may  be 
developed.  In  connection  with  the  industry,  dispensaries, 
hospitals,  schools,  baby  conferences,  prenatal  care,  visiting 
housekeepers,  recreation  centers  and  other  social  agencies  in 
addition  to  a  visiting  nurse  service  may  be  available  to  the 
employes.  They  will  all  add  to  the  well-being  of  the  people. 
When  the  community  realizes  the  need  of  any  one  of  these 
agencies,  the  employer  may  well  abandon  the  service  and 
assist  the  community  in  establishing  it,  strengthening  its 


THE  VISITING  NURSE  IN  INDUSTRY         73 

activities  through  his  own  cooperation,  and  that  of  his  health 
department  and  his  visiting  nui-ses.  In  this  way  the  em- 
ployer becomes  a  strong  force  for  the  improvement  of  the 
general  health  and  happiness  of  the  community. 

In  large  progressive  towns,  already  provided  with  a  visiting 
nurse  association,  baby  welfare  agency,  and  other  efficient 
means  for  public  health  education,  the  employer  often  wisely 
hmits  industrial  nursing  activities  outside  the  plant  to  a 
nursing  service  which  will  seek  out  the  family  of  each  sick 
worker  and  then  cooperate  with  existing  agencies  for  the 
care  of  the  sick  and  the  education  of  the  family  in  habits  of 
health. 

After  the  first  visit  is  made  and  the  right  contact  estab- 
Hshed  between  the  patient  and  the  firm,  a  great  saving  of 
time  and  duplication  of  effort  will  often  be  made  by  arranging 
with  the  local  visiting  nurse  association  for  the  subsequent 
bedside  care.  The  family  is  saved  the  unnecessary  visits  of 
numerous  health  workers  and  from  what  sometimes  seems  to 
the  patient  conflicting  advice. 

There  is  much  discussion  as  to  whether  public  health 
nursing  should  be  general,  each  visiting  nurse  attending  to  all 
nursing  in  a  neighborhood,  or  specialized,  one  nurse  looking 
after  the  babies,  another  attending  to  the  maternity  cases,  a 
third  visiting  the  tuberculous  patients.  One  method  pre- 
vails in  one  locality,  the  other  method  in  another  locahty. 
Whatever  the  wisdom  of  each  course,  the  industrial  nurse 
must  always  generalize.  In  so  far  as  there  are  practical  ways 
of  cooperating  with  other  nurses,  specialization  may  be 
possible,  but  the  most  efficient  industrial  nurse  is  one  who  is 
the  "  family  nurse  "  of  each  worker  in  much  the  same  way  as  a 
physician  becomes  a  family  doctor. 

Where  the  industrial  visiting  nurse  depends  on  the  local 
visiting  nurse  association  for  bedside  care  of  her  patients,  she 
should  not  feel  that  this  relieves  her  of  all  responsibility  for 
actual  nursing  work.  When  she  finds  something  to  be  done, 
she  will  lose  greatty  in  the  estimation  of  those  she  visits  if 
she  allows  the  need  to  wait  for  the  visit  of  another  nurse. 


74  INDUSTRIAL  NURSING 

She  should  always  be  ready  to  give  actual  bedside  care.  She 
may  seldom  require  a  visiting  nurse  bag  but  she  should 
carry  one,  and  keep  it  as  well  supplied  and  in  as  good  order 
as  would  be  expected  of  a  nurse  giving  only  bedside  care. 
(This  same  bag  or  another  like  it  is  often  useful  for  carrying 
about  the  plant  for  use  in  cases  of  emergency  when  the 
patient  cannot  be  carried  to  the  first  aid  room.) 

Cooperation  with  the  local  visiting  nurse  association  means 
the  loss  of  some  of  the  value  of  personal  service  to  the  worker 
and  the  resulting  close  personal  contact.  On  the  other  hand, 
it  aids  in  the  support  of  a  needed  community  agency  and 
makes  possible  the  nursing  care  of  many  workers  without  a 
great  increase  in  the  size  of  the  industrial  nursing  staff.  Such 
cooperation  has  been  found  useful  in  several  cities.  In  some 
cities  a  charge  of  fifty  cents  a  visit  has  been  made  and  in 
others  the  firm  pays  into  the  funds  of  the  visiting  nurse 
association  a  fixed  annual  sum  (ten  cents  in  one  place)  for 
each  employe  on  the  pay  roll. 

An  easy  way  of  starting  such  a  service  for  employes  is  to 
have  the  work  entirely  undertaken  by  the  local  visiting  nurse 
association.  The  visits  can  be  made  by  the  nurses  in  their 
districts  or  by  the  association  appointing  one  nurse  to  do  the 
work  of  one  plant,  the  nurse  being  responsible  both  to  the 
firm  and  to  the  association.  This  plan  has  the  advantage  of 
assuring  the  continuation  of  nursing  service  in  spite  of  changes 
of  personnel,  and  offers  supervision  to  inexperienced  workers. 
Unless  the  nurse  doing  such  work  spends  some  regular  time 
in  the  plant  and  becomes  identified  with  it,  there  may  be  very 
little  adaptation  of  the  work  to  the  needs  of  the  iildustry  and 
less  of  the  close  personal  relationship  which  should  exist 
between  the  nurse  and  patient,  not  because  the  nurse  is  a 
nurse  but  because,  in  addition,  she  is  the  personal  representa- 
tive of  the  company,  or  of  the  organization  of  workers  who 
employ  her,  and  is  known  to  have  been  chosen  by  them  and  to 
be  responsible  to  them. 

In  any  of  these  plans  great  elasticity  will  be  needed  to 
avoid  duplication  of  work  and  to  maintain  the  closest  possible 


THE  VISITING  NURSE  IN  INDUSTRY         75 

relation  between  the  industrial  nurse  and  those  she  visits. 
Aside  from  pointing  out  the  relative  advantages  and  dis- 
advantages of  each  method,  as  they  appear  to  the  writer,  no 
general  solution  can  be  offered.  The  needs  of  the  industry, 
the  local  agencies  at  hand,  the  prejudices  of  the  workers  and 
many  other  factors  will  guide  the  employer  in  his  decision 
as  to  what  means  he  shall  take  to  establish  a  visiting  nurse 
ser\ace.  Good  and  valuable  work  is  possible  for  the  nurse  no 
matter  what  the  details  of  organization  may  be. 

One  prejudice  of  workers  should  be  considered.  In  many 
towns  the  visiting  nurse  association  has  the  name  of  being  a 
charity.  Where  it  is  not  plain  that  the  association  serves  all 
classes  and  collects  pay  for  service,  consideration  for  the 
workers  often  influences  the  employer  in  establishing  his  own 
service  with  its  resulting  benefits  to  the  firm  and  greater 
acceptabihty  to  the  workers. 

The  visiting  nurse  in  industry  meets  the  same  problems 
and  must  handle  them  in  the  same  manner  as  any  other 
visiting  nurse.  The  backing  of  the  company  is  perhaps  not  so 
strong  or  general  as  that  of  a  good  visiting  nurse  association 
because  all  the  elements  of  the  population  are  not  repre- 
sented.^ ^ 

The  local  physicians  sometimes  feel  that  a  nurse  has  been 
thrust  upon  them  unasked  but  they  are  usually  glad  to  accept 
her  services  for  their  patients  when  they  find  her  obedient  to 
their  orders,  quick  in  reporting  a  change  in  a  patient's  condi- 
tion and  thorough  in  her  care  of  the  sick. 

Her  technique  should  be  that  of  the  best  visiting  nurse 
associations  ^  and  because  she  is  so  often  without  supervision, 
she  should  be  careful  to  make  it  plain  that  she  can  keep  up 
the  standard  of  her  work  without  example  or  precept. 

^  In  this  connection,  help  and  inspiration  are  to  be  found  in  Miss 
Gardner's  "  PubUc  Health  Nursing,"  Part  II,  Chapter  V,  The  Nurse 
Working  Alone. 

2  Where  the  nurse  is  paid  by  an  association  of  employes  or  of  em- 
ployers with  employes,  the  nurse's  backing,  at  least  with  her  patients, 
is  all  that  can  be  desired. 

»  "  Visiting  Nm-se  Manual,"  Edna  L.  Foley,  R.  N.,  page  43  to  page  71. 


76  INDUSTRIAL  NURSING 

In  a  small  industrial  town,  a  nurse  who  expects  to  do  bed- 
side nursing  in  the  homes  of  the  workers  will  gain  by  taking 
the  time  at  first  to  call  on  each  physician  in  the  community. 
In  either  a  small  town  or  in  a  large  city,  if  there  is  a  visiting 
nurse  association  having  standing  orders  approved  by  all  the 
doctors,  the  industrial  visiting  nurse  will  do  well  to  follow 
these  orders  in  her  work  in  the  homes.  If  she  is  the  only 
visiting  nurse  and  especially  if  she  is  a  newcomer,  it  may  be 
well  to  obtain  if  possible  such  orders  through  the  local 
medical  society.  The  advisability  of  this  step  will  depend  on 
local  conditions.  Sometimes  one  or  more  local  physicians 
may  take  this  matter  up  for  the  nurse,  or  her  employer 
may  be  willing  to  do  so.  After  the  nurse  becomes  known 
she  may  be  able  to  do  it  for  herself.  Until  some  standing 
orders  are  provided  for  her  use  she  will  necessarily  use  great 
caution  in  doing  anything  for  her  patients  except  to  make 
them  comfortable  until  she  has  consulted  the  physician  in 
charge. 

The  wise  general  rule  for  visiting  nurses  will  be  observed: 

"  It  is  a  wise  rule  that  a  doctor  shall  be  in  attendance  on 
every  case  cared  for  by  public  health  nurses  and  it  is  an 
equally  wise  rule  that  the  nurse  should  continue  on  the  case 
only  if  it  is  his  pleasure.  It  will  usually  be  his  pleasure  if  she 
does  her  work  well,  or  if  he  finds  that  patients,  as  often  hap- 
pens, refuse  to  call  him  unless  he  permits  such  service.  In 
case  of  change  of  doctor,  and  every  public  health  nurse  is 
familiar  with  the  dizzy  rapidity  with  which  such  changes 
take  place,  it  is  her  duty  to  put  herself  in  immediate  com- 
munication with  the  new  doctor,  and  usually  it  is  wise  to 
have  a  word  on  the  subject  with  the  departing  one,  lest  she 
become  involved  in  the  complexities  of  the  situation."  ^ 

The  work  of  the  industrial  visiting  nurse  differs  from  that 
of  the  ordinary  visiting  nurse  in  that  most  patients  visited 
are  seen  in  their  homes  by  the  nurse  before  the  doctor  has 
been  consulted.  Often  the  worker  is  not  sick  but  at  home  for 
other  reasons.  In  many  cases,  though  not  well,  he  does  not 
1 "  Public  Health  Nursing,"  Miss  Mary  S.  Gardner,  page  45. 


THE  VISITING  NURSE  IN  INDUSTRY         77 

consider  his  illness  of  enough  importance  to  warrant  the 
expense  of  a  doctor's  visit.  The  nurse's  duty  is  to  persuade 
the  patient  of  the  wisdom  of  seeing  a  doctor  if  necessary  and 
then,  if  illness  continues,  to  see  that  he  understands  and 
carries  out  his  physician's  orders  and  that  he  has  whatever 
nursing  care  is  required,  teaching  the  patient  and  his  family 
as  would  any  other  visiting  nurse. 

Every  employ^  must  be  acquainted  with  the  medical, 
surgical  and  nursing  services  at  his  command.  While  nothing 
should  be  forced  upon  any  one,  the  worker  may  surely  be 
taught  by  a  sympathetic  friend  (the  nurse,  or  if  he  does  not 
know  her  well,  his  neighbor  who  has  known  her  longer)  to 
want  what  is  to  be  of  benefit  to  him. 

When  visiting  nursing  is  established  in  an  industry,  a 
systematic  method  by  which  calls  come  to  the  nurse  is  neces- 
sary. Calls  will  undoubtedly  come  from  many  sources;  from 
the  emplojmient  office,  the  heads  of  departments,  the  workers, 
the  company  physician,  and  from  the  families  of  the  work- 
ers, as  well  as  from  outside  sources  such  as  the  visiting  nurse 
association,  industrial  benefit  associations,  churches,  etc. 
However,  in  order  to  be  really  efficient,  each  absentee  should 
be  visited  at  least  once  unless  it  is  definitely  known  that  he  is 
not  sick  or  that  he  needs  no  help.  A  regular  daily  system  of 
notification  from  the  employment  office  or  from  the  time- 
keepers is  the  only  way  by  which  those  needing  aid  can  be 
promptly  reached.  In  a  small  town  the  nurse  may  "happen 
to  hear"  of  those  needing  her  help  but,  even  in  the  smallest 
place,  this  is  an  uncertain  way  of  getting  work  done  and 
in  a  city,  where  the  need  is  often  greatest,  it  is  of  no  value 
at  all. 

Without  prompt  visits  to  all  absentees,  a  great  amount  of 
preventable  misery  is  sure  to  occur,  such  as  the  case  in  New 
York  City  where  a  cook,  employed  in  a  restaurant,  was  away 
from  work  on  Friday.  Her  absence  was  reported  to  the  nurse 
on  Monday  morning  and  in  the  afternoon  a  visit  was  made. 
The  patient  was  alone  and  no  one  had  entered  her  furnished 
room  since  the  preceding  week.     She  was  delirious,  her 


78  INDUSTRIAL  NURSING 

temperature  was  104,  two  gas  lights  and  an  oil  heater  were 
burning  and  the  month  was  August.  No  time  was  lost  in 
sending  the  irresponsible  patient  to  the  hospital  in  an  am- 
bulance, where  it  was  found  that  she  was  suffering  from 
typhoid  fever.  Her  friends  had  gone  to  the  country  for  a 
vacation  and  did  not  appear  for  several  days.  This  is,  of 
course,  an  extreme  case,  but  it  is  not  at  all  unusual  to  find  a 
person  ill  and  in  need  of  care  but  without  the  least  idea  of 
how  to  go  about  getting  help. 

The  industrial  nurse  who  visits  in  the  homes  will  not  act  as 
a  detective,  and  the  private  affairs  of  her  patients  will  be 
treated  with  the  same  consideration  and  confidence  as 
similar  information  coming  to  the  attention  of  the  private 
duty  or  hospital  nurse.  When  her  patients  have  learned 
confidence  in  her  discretion  her  opportunities  for  giving  real 
help  will  be  greatly  increased.  Many  personal  matters  are 
sure  to  come  to  the  industrial  nurse's  attention  which  concern 
no  one  but  the  patient  or  possibly  his  family.  It  is  sometimes 
necessary  to  get  the  sympathy  and  understanding  of  the  em- 
ployer or  of  someone  else  high  in  authority  and  in  close  touch 
with  the  plant.  The  privilege  of  consulting  at  will  with  the 
employer  or  general  manager  is  often  allowed  an  industrial 
nurse  and  should  be  greatly  valued  by  her.  If  she  remem- 
bers the  many  demands  upon  his  time  and  his  great  responsi- 
bilities, is  sure  of  the  accuracy  and  importance  of  her  facts 
and  presents  them  briefly,  many  an  employer  is  only  too  glad 
to  give  freely  of  his  time  and  interest.  An  industrial 'nurse 
should  beware  of  the  failing  of  continually  asking  favors  for 
employes.  Favors  do  not  bring  any  desirable  results  to 
anyone. 

The  visiting  nurse  in  industry  will  work  with  the  various 
family  physicians  of  her  patients  rather  than,  as  in  the  first 
aid  room,  solely  with  the  company  physician.  Coming,  as 
she  often  does,  without  the  knowledge  of  the  familj^  doctor  or 
even  before  he  has  been  called  to  attend  the  patient,  she 
must  make  it  very  plain  to  both  doctor  and  patient  that  she  is 
carrying  out  the  best  principles  of  nursing  ethics  and  the 


THE  VISITING  NURSE  IN  INDUSTRY         79 

best  visiting  nurse  technique.  She  should  be  exact  and  par- 
ticular in  keeping  all  bedside  notes  and  records,  both  in  the 
patient's  home  and  in  the  nurse's  office  at  the  plant.  Her 
responsibihty  is  fourfold:  to  her  patient,  to  his  physician,  to 
her  employer  and  to  herself.  Only  by  the  same  careful 
record  of  orders,  treatments  and  observations  as  is  required 
in  a  hospital  can  a  nurse  protect  herself  from  chance  of 
criticism.  Her  continued  usefulness  in  her  chosen  work  may 
sometime  depend  upon  promptly  recorded  facts.  The  visit- 
ing nurse  must  spend  enough  time  in  the  plant  to  keep  her 
records  or  to  see  that  they  are  kept,  to  get  her  calls  and  to  see 
workers  in  the  plant  who  may  wish  to  consult  her.  The  noon 
hour  will  often  be  a  good  time  to  see  the  workers. 

The  visiting  industrial  nurse  does  not  finish  her  duties  when 
her  patient  no  longer  needs  nursing  care.  She  will  be  ex- 
pected to  keep  in  touch  with  him  until  he  is  able  to  go  to 
work.  This  attention  during  convalescence  is  an  important 
factor  in  keeping  the  worker  patient  until  he  is  fully  recov- 
ered and  in  adjusting  him  to  his  work  later.  Arrangements 
for  medical  examination  by  the  company  doctor  should  be 
made  when  necessary  to  prevent  the  worker  returning  too 
soon  or  while  in  a  condition  to  be  a  menace  to  others.  Many 
firms  make  such  an  examination  a  routine  requirement,  and 
where  this  is  not  the  case,  the  industrial  nurse  should  assure 
herself,  as  far  as  she  can,  through  consultation  with  the 
family  physician,  that  the  patient  is  able  to  return  and  that 
he  has  suitable  work.  This  precaution  is  of  special  impor- 
tance where  the  illness  has  been  long  or  obscure,  where  indus- 
trial disease  has  not  been  excluded,  and  in  all  respiratory 
diseases. 

After  return  to  work  many  patients  should  be  kept  under 
friendly  observation  by  the  first  aid  room  nurse.  Some  will 
need  to  be  reminded  to  return  to  their  doctors;  perhaps  the 
foreman  will  have  to  be  asked  for  a  time  allowance  for  the 
visit.  Some  may  be  ordered  treatment  by  their  doctors  which 
will  have  to  be  given  by  the  nurse  in  the  first  aid  room. 
Others  may  not  seem  strong  and  the  nurse  may  make  some 


80  INDUSTRIAL  NURSING 

excuse  to  get  them  to  her  office  from  time  to  time  in  the  noon 
hour.  Young  persons  and  others  will  have  weight  cards  kept 
so  that  the  nurse  will  be  able  to  give  the  doctor  valuable  in- 
formation in  sending  a  patient  to  him.  The  first  aid  nursing 
and  the  visiting  nursing  are  inseparable  if  good  team  work  is 
to  be  done. 


CHAPTER  IX 


THE    DAY  S    WORK 


The  First  Aid  Room: — The  first  aid  room  nurse  or  her  clerk 
will,  in  most  plants,  be  expected  to  open  the  first  aid  room 
when  work  begins  in  the  morning.  Where,  as  in  urgent  war 
work,  the  plant  runs  continuously,  the  first  aid  room  will 
probably  never  be  closed.  Some  firms,  under  these  condi- 
tions, employ  a  male  attendant  for  the  night  work.  There  is, 
however,  no  more  reason  to  exclude  a  nurse  from  night  work 
in  an  industrial  first  aid  room  than  to  expect  hospital  order- 
lies to  do  all  the  night  work  in  a  hospital.  Nevertheless  such 
use  of  a  woman's  time  might  be  considered  a  violation  of  the 
labor  laws  of  some  states.  With  three  shifts  of  nurses,  a 
comfortable  time  schedule  would  be  possible  and  the  night 
workers,  who  are  surely  not  less  hable  to  injury  and  illness 
than  the  day  force,  would  have  the  same  protection.  Em- 
ployers, who  have  had  experience  with  both  nurses  and  male 
attendants,  are  unanimous  in  saying  that  the  former  are  more 
efficient,  more  interested  and  to  be  preferred  even  in  estab- 
hshments  where  the  employes  are  all  or  chiefly  men. 

Any  objection  a  nurse  might  have  to  such  employment, 
aside  from  the  disadvantages  inseparable  from  any  night  duty, 
vanish  when  she  learns  how  much  respect  even  the  roughest 
man  has  for  a  trained  nurse.  The  writer  has  yet  to  hear  of 
even  one  instance  of  intentional  rudeness  or  disrespect  from 
any  male  employe  to  any  industrial  nurse  at  any  time.  It 
would,  nevertheless,  be  wise  in  choosing  trained  nurses  for  night 
work  to  select  women  of  exceptional  dignity  and  mature  years. 
A  well  placed  first  aid  room  will  not  be  in  an  isolated  location 
and,  if  used  at  night,  care  should  be  taken  to  have  it  where 
all  that  goes  on  within  may  be  easily  observed  from  without. 

In  a  plant  requiring  continuous  first  aid  service,  the  indus- 
trial nurse  will  probably  be  fully  occupied  with  first  aid  work 
and  redressings,  together  with  the  care  of  workers  who  are 

81 


82  INDUSTRIAL  NURSING 

taken  sick  in  the  plant.  In  order  to  have  any  time  at  all  for 
other  work,  or  even  for  acquiring  a  general  knowledge  of  the 
industry,  most  careful  planning  of  work  is  necessary.  If  all 
possible  routine  duties  are  attended  to  in  the  early  hours, 
emergencies  are  more  easily  handled  and  time  is  more  likely 
to  be  found  for  developing  and  improving  the  service.  First 
aid  room  work  increases  and  decreases  with  the  seasons,  with 
the  pressure  of  work  throughout  the  plant,  with  the  weather, 
even  with  slight  changes  in  factory  routine  or  department 
management,  so  that  at  times  there  may  be  comparatively 
little  to  do.  When  these  times  come,  the  nurse,  whose  routine 
work  is  always  finished  at  as  early  an  hour  as  possible,  will 
find  leisure  to  study  her  problems  and  improve  her  methods. 
Getting  the  workers  to  return  for  redressings  at  the  exact 
time  they  have  been  instructed  to  come  will  often  be  a  diffi- 
culty. In  one  place  this  was  overcome  by  giving  a  printed 
shp  at  the  first  visit.  This  slip  the  patient  took  to  the  fore- 
man who  kept  it  on  file  and  sent  it  back  to  the  first  aid  room 
with  the  patient  at  each  visit.  The  same  paper  served  until 
the  case  was  closed,  when  that  fact  was  entered  for  the 
further  information  of  the  foreman.    Sample  slips  follow: — 

^^>An     Qce,        No.  2S3.    Dept.  60. 
Remarks,     ^aui    Ae    i>vA»    aoaale^    ueiiei^i/au. 

Injured,  (f/^^.  19/<i',  ^0  ,^.^^.   Nature  of  in  jury,  «»8^<»«>^<*!«w/ 
Disposition,  ienf  &>   iSi.    S^i^. 


/lerman,. 


incapacity,     Ayoww/u    onlw    lo-dau,     iee    doc/or^    r^A^ir/i 

Return  to  first  aid  room  ?   yes. 

To  return  to  Dr.  at         A.  M.        P.  M. 

Send  to  first  aid  room  6\ys  ^  ai  m»^  g  s^.  ^. 

Zi^.  ji:.  ^.,  Nurse. 


THE  DAY'S  WORK  83 

Or— 

^^m»  £4.    19/<f 
^y^ar^  5/inid,    No.     35.     Dept.    3. 
Remarks,    Mc/;,     toi//  ie«  ^imi/u.    e/oc&^r. 

Injured, /f/s*,  \^^s.  ^Ios0^.  ^i  Nature  of  injury,  ^^^^^  //;«. 

Disposition,     i^movecl   ^/inle^,     ien/   Aom«    iecanie    iicJc. 
Incapacity,     comA/ele     of    Aiieient,     it'<im     MneM     nof   ituui^. 

Return  to  first  aid  room  ?     em  I'eAttvi.  lo  nu/^. 

To  return  to  Dr.  at         A.  M.         P.  M. 

Send  to  first  aid  room   viiOin^  Tu^ne  6>  cal^  da  0^.  ^. 

J^  ^.  ^.,  Nurse. 

A  new  date  for  return  is  entered  at  each  visit  unless  the 
case  is  closed,  then  "HEALED"  is  written  diagonally  across 
the  sheet  and  it  is  sent  again  to  the  foreman.  The  returns  are 
checked  up  by  means  of  the  day  book  and  patients'  individual 
cards  which  will  be  described.  The  careful  following  up  of 
those  who  do  not  return  when  expected  is  a  necessary  part 
of  the  duties  of  the  first  aid  room  nurse,  both  for  the  safety  of 
the  patient  and  for  the  protection  of  the  company  from 
accusation  of  neglect  or  from  possible  unjust  claims.  The 
first  aid  nurse  need  not  go  to  the  patient's  home  but  she 
should  be  able  to  send  some  reliable  person.  It  is,  however, 
more  satisfactory  for  the  nurse  to  go  herself.  A  patient  need- 
ing slight  dressing  might  become  ill  from  other  causes  and  no 
home  visitor  would  know  the  right  thing  to  be  done  or  do  it  as 
well  as  the  nurse.  In  cases  where  there  is  doubt  as  to  whether 
the  illness  had  itsorigin  from  the  injury, the  nurse  will  see  that 
the  patient  is  again  placed  under  the  observation  of  the  com- 
pany physician.  She  will  be  able  to  assist  the  foreman,  the 
employment  ofiice  and  the   compensation  department  by 


84  INDUSTRIAL  NURSING 

weeding  out  those  workers  who,  having  suffered  a  small 
injury,  stay  at  home  and,  without  notifying  the  employer, 
take  work  elsewhere  or  even  move  out  of  town. 

When  workers  are  taken  ill  during  working  hours,  the  nurse 
will  often  be  obliged  to  follow  them  to  their  homes  in  order  to 
make  sure  of  excluding  contagion  from  the  plant.  Where  no 
regular  visiting  nurse  service  is  provided,  the  jfirst  aid  nurse 
will  have  frequent  reason  to  know  that  workers  who  should 
have  help  and  advice  are  at  home  and  not  likely  to  get  either 
unless  their  condition  becomes  alarming  to  the  inexperienced 
family  or  indifferent  landlady. 

Much  interesting  follow-up  work,  for  which  nurses  find  the 
need  in  the  first  aid  room,  must  wait  until,  a  visiting  nurse 
service  is  established.  The  nurse  must  return  to  a  room  full 
of  workers  who  need  prompt  attention  to  avoid  loss  of  time, 
idle  machines,  personal  loss  of  money  to  piece  workers,  con- 
fusion in  the  departments  of  the  plant  and  an  upsetting  of  the 
whole  system  by  which  a  busy  day  may  go  through  without 
worry,  haste  or  confusion. 

After  a  little  experience,  the  first  aid  nurse  will  know  about 
how  many  dressings  she  can  do  in  half  an  hour,  and  the  ap- 
pointments for  the  workers  may  be  so  arranged  that  time  is 
not  wasted.  In  some  departments,  it  will  be  easier  for  the 
foremen  to  send  all  his  people  to  the  first  aid  room  and  have  it 
over  with.  In  other  departments,  where  machines  might  be 
idle  if  several  workers  left,  cooperation  will  be  easier  if  the 
workers  are  allowed  to  come  to  the  first  aid  room  one  at  a 
time.  These  things  can  only  be  learned  by  experience  in  the 
industry  itself.  Thought  and  consideration  in  these  matters 
will  be  part  of  the  nurse's  contribution  to  good  team  work. 
In  opening  a  new  first  aid  department,  some  confusion  is 
inevitable,  but  much  can  be  avoided  by  thought  and,  after  a 
week  or  so,  the  return  of  patients  should  be  so  systematized 
that  it  is  accurately  accomplished  with  little  trouble  and 
almost  no  friction. 

For  the  quick  handling  of  many  small  dressings,  mostly 
fingers,  the  following  plan  works  well. 


THE  DAY'S  WORK  85 

The  automatic  return  of  the  patients  having  been  assured 
and  everything  in  the  dressing  room  being  ready,  the  clerk 
sits  at  a  table  near  the  door  with  the  daybook,  patients' 
individual  cards,  pad  of  return  slips  for  foremen,  duplicate 
book  for  writing  notes  to  the  company  doctor,  duplicate 
book  for  sending  reports  to  the  main  office  and  any  other 
forms  that  may  be  required  by  the  particular  plant.  The 
clerk  enters  all  names  in  the  daybook  as  the  patients  come 
in,  takes  the  slips  which  they  have  brought  from  their  fore- 
men, and  fills  in  the  proper  spaces  in  the  daybook  as  the 
nurse  tells  her  what  to  write.  She  marks  the  foremen's  slips 
as  directed  by  the  nurse  and  has  them  ready  to  give  to  the 
patient  as  he  leaves  the  room.  In  odd  moments  she  will, 
perhaps,  be  able  to  assist  in  sterilizing  instruments,  in  keeping 
the  dressing  table  in  order  and  in  putting  on  some  bandages. 
A  few  lessons  in  bandaging  will  interest  her  and  the  knowl- 
edge will  be  useful.  In  a  busy  room,  however,  the  clerk  will 
be  fully  occupied  with  the  record  table  until  the  routine  work 
is  finished. 

The  nurse  stands  between  the  stationary  basin  and  the 
dressing  table,  the  dressing  table  on  her  right.  The  dressings 
will  then  be  done  as  rapidly  as  possible.  Even  so  the  nurse 
will  find  opportunity  to  teach  the  patients  many  things. 
Where  the  dressings  are  of  a  simple  nature,  it  helps  to  have 
as  many  persons  waiting  in  the  first  aid  room  as  possible. 
There  is  little  to  be  said  about  first  aid,  the  necessity  of 
prompt  visits  to  the  first  aid  room  and  the  folly  of  neglect  to 
use  all  safety  devices  provided,  that  will  not  be  more  im- 
pressive if  heard  by  the  workers  in  groups.  The  feeling,  as 
the  workers  often  say,  that  "the  nurse  won't  like  it"  is  a 
strong  factor  and  not  to  be  overlooked  in  maintaining  proper 
discipline.  Nevertheless,  while  this  sort  of  publicity  may  do 
good  in  a  mill  or  with  young  people,  it  is,  doubtless,  totally 
unsuited  to  some  other  industries  or  to  people  who  are  shy. 
It  has  no  use  or  excuse  in  any  dealings  with  the  personal 
affairs  of  anyone.  Where  such  groups  are  together  nat- 
urally and  comfortably,  workers  and  nurse  have  a  chance  to 


86  INDUSTRIAL  NURSING 

become  acquainted,  the  workers  learn  a  good  deal,  especially 
as  to  what  they  must  not  expect  the  nurse  to  do  for  them,  and 
the  nurse,  if  she  is  not  easily  confused,  enjoys  the  informal 
"meeting." 

A  conspicuous  sign  in  the  first  aid  room  to  the  effect  that 
the  nurse  will  be  in  her  office  between  twelve  and  one  to  see 
any  one  who  wishes  to  consult  her  will  make  that  a  busy 
hour  and  will  do  much  to  leave  the  early  hours  free  for  the 
routine  work  of  the  plant. 

A  sample  page  from  a  first  aid  room  daybook  will  give  an 
idea  of  what  may  happen  during  an  average  day  in  a  plant 
employing  five  thousand  or  more.  Purposely,  a  day  was 
chosen  in  which  no  startling  accidents  occurred.  Very  serious 
injuries  are  uncommon  in  modern  plants  and,  while  almost 
anything  may  happen,  such  occurrences  would  make  a  day 
anything  but  average.    The  names  are,  of  course,  fictitious. 

Where  a  daily  report  is  sent  to  the  general  manager,  the 
main  office  or  elsewhere,  a  book  with  duplicate  pages  and 
carbon  paper  permits  the  day's  record  to  be  used  as  it  is  for 
the  report,  while  the  carbon  copy  remains  in  the  book  for  a 
permanant  record  and  for  use  in  writing  up  the  patients' 
individual  cards.^ 

The  daybook  is  planned  to  record  all  that  happens  during 
the  day:  the  patients  seen,  the  treatments  given,  outside 
visits  of  the  nurse,  unless  there  is  a  regular  visiting  service, 
in  which  case  convenience  may  require  separate  records  and 
a  special  daybook  for  the  visiting  work.^ 

^  See  Chapter  X,  Records. 

*The  National  Organization  for  Public  Health  Nursing  has  devised 
an  excellent  system  of  day  book  and  record  card  for  visiting  nursing 
which  is  adaptable  to  the  requirements  of  many  industrial  nurses. 


THE  DAY'S  WORK 


87 


Cotton,  Wool  &  Company 
First  Aid  Room 


Dallas  Branch 

Daily  Report 

Dec.  23rd,  191S 

Time 

Return 

Name 

No.  Depl. 

Disability 

Disposition,  Treatment,  Remarks 

8 

12/24 

J.Lee 

3  Spin. 

Crushed  1  f.  L. 

Wet  boric.  To  Dr.  Chief.  Caught 
in  frame. 

12/24 

A.  Brown 

Mach. 

Nail  torn 
tip  th.  L. 

Returned    to    work. — Accident 
at  home,  6:30  a.  m.  3%  iodine, 

dry  ster. 

12/24 

B.  Smith 

6  Dye. 

SI,  bum  top  L. 

foot 
Burn  L.  eye 

Moist  boric.    Dye  slopped. 

12/24 

C.  Coe 

10  Bleach. 

Flushed  in  dept.  Wh.  wine  vin. 

Eye  specialist.    Emptying  drum 

of  caustic  soda  carelessly. 

9 

12/24 

H.  Hoe 

14     " 

Burn  L.  foot,  si. 

Water,  vin.    B.  A.  Oint. 
Did   not   take   time   to   put  on 
boots.    Caustic  soda. 

Healed 

M.  May 

56  Carp. 

Redressing 

As  before.     Order  Dr.  Chief. 

Healed 

N.  Kay 

87  Paint. 

Spr.  ankle 

Massage,  bandage.     Order  Dr. 
Chief. 

10 

12/24 

C.Tate 

98  Office 

Lac.  1  f.  1. 

3%  iodine,  dry  ster.     Sharpen- 
ing pencil. 

~ 

I.  Butts 

6  Twist. 

Hysterical 

Rest     in     bed,     taken     home. 
Brother   had    enlisted    and    left 
for  Canada  to-day. 

12/24 

F.  Fay 

90  Tool 

Emery,  cornea,  L. 

Sent  to  eye  specialist. 
Left  off  goggles. 

12 

12/24 

E.  Day 

10  Test. 

Under  weight 

83  lbs.  Saw  Dr.  T.  12/21  Brought 
well  planned  lunch.     Adv.  aa 

to 

to  habits. 

1 

12/26 

D.Wat 

97  Stenog. 

Var.  veins 

Bandaged.    Surgeon  adv.  no  op. 
Measure    for    stocking    next 
visit  8  A.  M.                            , 

1/8 

D.  M.  Potts 

6  Fin. 

Went    to    T.   B. 

Gaining, 
r  Deserted  by  h 

Clinic    12/21.     To    return   l/7. 
usband,  2    ch.,   1    &  4,  at  day 

1/8 

G.  Kane 

56  SP. 

1        nursery. 

1    Referred  to  12 

[  Foreman  will  a 

Main  St.  re  mother's  pension. 
How  time,  P  M. 

Following     home   visits    made. 
See  cards. 

2 

Mary 

Smith    123 

Noman  A 

ve. 

to 

Beatri 

ce  Brown,  8 

9  Smith  S 

t. 

4 

Marga 

ret  Conley, 

978  Bush 

St. 

Following     parts     of      factory 
visited. 

4 

Bleach 

House  re  C 

oe  &  Hoe 

See  spec,    report  re   goggles  in 

to 

Spin  3 

re  J.  Lee, 

Grinding  Room,  sent  in  dupli- 

6 

Tool're 

F.  Fay 

cate    to    Gen.     Mgr.,   Safety 
Dept.,    Head    of    Dept.    and 
foreman   of  room   after   con- 
ference with  head  of  dept.  and 

1 

foreman. 

The  full  number  of  cases  for  this  day  is  not  included.  To 
save  space,  fifty-six  first  aid  cases  and  redressings  are  omitted 
but  those  included  are  fairly  representative. 

This  is  a  good  opportunity  to  say  a  word  concerning  special 
reports  which  may  be  made  about  conditions  in  different 


88  INDUSTRIAL  NURSING 

departments.  The  cooperation  and  good  will  of  the  depart- 
ment heads  and  of  the  foremen  must  be  kept.  For  instance, 
in  the  case  of  the  goggles  mentioned  above,  there  were  not 
enough  in  the  room  to  supply  the  men;  they  had  been  ordered 
several  times.  The  report  was  made  to  every  one  who  could 
have  any  interest  in  the  affair,  after  talking  with  the  heads  of 
the  particular  part  of  the  plant.  This  conference  placed  the 
nurse  in  the  position  where  she  could  help  most.  The  wheels 
once  in  motion,  the  goggles  arrived  the  next  week. 

A  daybook  should  be  planned  according  to  the  size  and 
organization  of  the  plant.  One  at  least  twelve  inches  wide 
will  be  required  to  afford  space  for  the  information  needed 
in  every  case.    It  should  be  bound  at  the  top. 

A  regular  weekly  schedule  will  help  in  making  the  work 
go  smoothly  and  in  assuring  attention  to  easily  forgotten 
details.  It  is  helpful  to  have  both  daily  and  weekly  schedules 
of  work  posted,  both  as  reminders  to  the  present  force  and 
for  the  information  of  others  in  case  of  a  sudden  change  in 
personnel.  The  weekly  inspection  of  other  stations,  the  times 
at  which  first  aid  kits  from  outlying  parts  of  the  plant  are 
to  be  brought  in  for  replenishing,  etc.,  should  be  included. 

The  industrial  nurse  must  not  forget  that,  in  the  absence 
of  the  company  physician,  she  is  more  interested  in  the  first 
aid  room  than  any  one  else,  that  every  one  in  all  other  de- 
partments has  his  own  work  to  do  and  that  first  aid  will 
interest  him  less  than  his  own  duties  except  when  he  needs 
attention  for  himself  or  for  a  fellow  worker.  In  whatever 
way  responsibilities  may  have  been  delegated  to  others,  it 
still  remains  the  first  duty  of  the  industrial  nurse  to  see  that 
arrangements  for  the  handling  of  any  injury  are  not  only 
made,  but  that  they  are  maintained  in  a  serviceable  condition. 
Without  carefully  kept  schedules,  it  is  an  easy  matter  to 
forget,  in  the  pressure  of  daily  duties,  the  inspection  of  the 
respirator  at  the  fumigating  plant  or  the  renewal  and  prob- 
ably necessary  dilution  of  the  3%  iodine  which  was  left 
with  the  foreman  in  the  picking  room  to  prevent  trouble 
from  the  constant  pricking  of  the  men's  hands. 


THE  DAY'S  WORK  89 

Where  there  is  more  than  one  first  aid  station  a  daybook 
should  be  kept  in  each,  the  person  in  charge  writing  down 
every  occurrence  and  sending  the  original  record  to  the  nurse 
each  day.  By  this  means  the  record  cards  of  all  workers 
may  be  kept  in  the  main  station  and  the  nurse  is  able  to  see 
just  how  much  has  been  done  in  the  other  rooms.  The  last 
hour  or  hours  of  the  day  may  well  be  used  in  part  for  calling 
up  the  outlying  first  aid  stations,  inquiring  what  has  hap- 
pened and  making  sure  that  each  worker,  requiring  attention 
from  physician  or  nurse,  has  care  while  his  whereabouts  is 
still  known. 

It  is  perhaps  superfluous  to  repeat  that,  where  a  physician 
spends  all  or  a  regular  part  of  his  time  in  the  plant,  details 
of  organization  and  routine  rest  with  him.  Most  physicians 
are,  however,  glad  to  have  some  one  arrange  their  work  so 
that  they  are  not  obhged  to  spend  time  in  waiting  or  in  send- 
ing for  workers. 

In  some  plants  it  is  practical  for  the  first 'aid  nurse  to  spend 
certain  hours  only  at  the  plant  and  for  her  to  devote  a  good 
deal  of  time  to  home  visiting. 

The  keeping  of  records  is  so  much  a  part  of  the  day's  work 
that  it  has  been  impossible  to  omit  the  subject  entirely  from 
this  chapter. 


CHAPTER  X 

RECORDS   AND    REPORTS    FOR    FIRST   AID    ROOM   AND    VISITING 

NURSE 

The  records  kept  by  the  industrial  nurse  should  be  planned 
to  aid  her  in  meeting  her  fourfold  responsibility: — to  the 
worker,  to  the  physician,  to  her  employer  and  to  herself. 

For  the  benefit  of  the  worker,  the  mil  records  in  the  plant 
should  show  what  illnesses  and  accidents  he  has  suffered 
during  the  period  of  his  employment,  what  care  and  benefit 
or  compensation  he  has  had,  what  has  been  done  to  prevent 
future  disaster,  by  improvement  in  his  physical  condition,  by 
correction  of  his  physical  defects,  or  by  changes  in  the  con- 
ditions under  which  he  works;  together  with  the  physical 
condition  of  the  worker  on  employment,  his  educational 
advantages,  his  previous  experience,  his  home  surroundings 
and  his  working  record.^ 

All  this  is  possible  for  the  industrial  nurse  working  in  a 
small  plant  who  is  able  to  interview  each  new  worker,  to 
visit  his  home,  and  who  has  also  the  privilege  of  sending 
patients  at  will  to  the  company  doctor.  In  a  large  plant 
this  is  only  possible  by  routine  physical  examination  of  all 
new  workers  by  a  physician  and  home  visits  from  the  nurse, 
in  addition  to  the  closest  cooperation  in  record  keeping  be- 
tween physician  and  nurse  and  with  the  employment,  statis- 
tical and  safety  departments. 

The  illness,  accident,  work,  family  and  medical  records, 
if  kept  together,  present  a  picture  of  the  worker  which  is 
often  of  great  value  to  him  and  to  the  industry  by  making 
it  possible  to  place  him  where  he  will  do  the  best  work  and 
where  he  will,  consequently,  be  happiest  and  most  pros- 
perous. 

^  See  next  chapter  for  employment  records. 
90 


RECORDS  AND  REPORTS  91 

The  responsibility  of  the  industrial  nurse  to  the  attending 
physician,  whether  the  company  physician  or  the  family 
doctor,  requires  a  complete  account  of  the  doctor's  orders, 
of  all  the  nurse  does  for  the  patient  and  of  all  she  observes 
as  to  his  condition  and  surroundings. 

The  responsibility  of  the  nurse  to  her  employer  demands,  in 
addition  to  all  the  above,  an  account  of  how  time  and  pos- 
sibly funds  are  used  and  a  summary  of  results  attained. 

To  the  industrial  nurse  herself  the  records  are  indispensable. 
They  show  her  what  she  has  accomplished,  and  sometimes, 
even  more  iinportant,  that  which  she  has  not  accomplished. 
They  aid  her  memory,  prevent  duplication  of  effort  and  make 
changes  of  personnel  possible  with  the  minimum  of  confu- 
sion; they  make  her  work  intelligent  by  giving  her  a  picture 
of  the  worker  in  connection  with  his  environment  at  home  and 
at  work.  They  are  her  best,  and  sometimes  have  been  her 
only  protection  from  unjust  criticism  and  even  legal  complica- 
tions. 

The  proper  coordination  and  interpretation  of  records  is 
work  for  a  trained  statistician.  Full  description  of  methods 
of  record  keeping  now  in  vogue  would  fill  a  volume.  As  the 
organization  of  industry  for  safety,  efficiency  and  cooperation 
progresses,  standards  for  all  such  records  will  undoubtedly  be 
formed  and  more  or  less  uniform  systems  will  be  evolved  for 
the  different  industries.  These  problems  should  be  taken  up 
in  unison  by  organizations  interested  in  the  prevention  of 
illness  and  accident.  With  the  coming  of  health  insur- 
ance, state  authorities  may  require  certain  standards  for 
such  record  keeping  in  all  industries.  In  the  meantime 
each  plant  must  work  out  its  own  system  to  suit  its  needs, 
utilizing  the  help  and  guidance  of  expert  statisticians  when 
available. 

A  nurse,  beginning  industrial  nursing,  where  there  is  a 
statistical  department,  should  carefully  plan  out  her  own 
needs  in  the  keeping  of  records  and  note  the  ways  in  which 
her  records  should  be  useful  in  connection  with  those  of  the 
employment,  statistical  and  safety  departments. 


92  INDUSTRIAL  NURSING 

It  is  a  great  advantage  if  the  employer  permits  the  indus- 
trial nurse  to  have  access  to  the  records  of  other  departments 
which  may  add  to  her  knowledge  of  the  worker  as  an  in- 
dividual and  as  a  member  of  a  family,  and  of  the  conditions 
under  which  he  works,  with  their  influence  on  his  health  and 
efficiency.  Duplication  should  be  avoided.  After  the  nurse 
has  clearly  decided  what  records  she  needs,  consultation 
with  the  employer  will  usually  result  in  enlisting  for  her  the 
cooperation  of  the  other  departments  whose  records  may  be 
used  to  supplement  her  own  or  in  which  her  findings  will  be  of 
value — the  employment,  statistical  and  safety  departments  at 
least. 

This  interchange  of  records  must  not  be  allowed  to  affect 
the  privacy  of  the  personal  affairs  of  the  workers.  The  nurse 
will  need  memoranda  here  to  aid  her  memory  and  to  make 
much  of  her  work  of  permanent  use,  but  these  things  should 
be  absolutely  confidential  and  the  workers  should  know  that 
this  is  the  case. 

Where  the  company  physician  is  actually  employed  in  the 
plant  at  regular  times,  he  will  probably  have  his  own  records 
which  may  supplant  a  part  of  the  nurse's  records  or  which 
may  be  supplemented  by  them.  In  a  medical  department 
with  a  physician  in  regular  attendance  the  medical  and 
nursing  records  should  be  kept  in  harmony  and  without 
dupHcation,  but  the  final  broad  use  of  material  gathered 
should  rest  with  the  physician  unless  he  prefers  to  delegate 
such  work  to  the  nurse. 

The  writer,  not  being  a  statistician,  can  only  suggest  to  the 
industrial  nurse  methods  by  which  she  will  be  able  to  keep 
her  own  work  in  hand  from  the  first  day  of  her  employment, 
without  waiting  for  the  development  of  all  records  necessary 
for  full  efficiency. 

We  will  assume  that  the  nurse  is  employed  to  begin  indus- 
trial nursing  in  a  plant  with  the  minimum  of  medical  service 
from  the  company  physician. 

Before  taking  up  her  duties,  if  there  is  time,  she  should  ask 
to  be  provided  with  a  daybook  such  as  has  been  described  in 


RECORDS  AND  REPORTS 


93 


the  last  chapter.  With  the  addition  of  some  record  cards  in 
two  colors,  one  color  for  industrial  injuries  and  the  other 
color  for  all  other  cases,  the  nurse  will  be  able  to  keep  an 
accurate  account  of  all  that  happens  in  her  department. 
She  will  need  a  small  box  with  alphabetical  guide  for  open 
cases  and  a  filing  cabinet  for  closed  cases.  If  work  must 
begin  before  printing  can  be  done,  a  large  blank  book  must 
serve  as  a  record  and  the  proper  cards  be  made  out  as  soon  as 
they  can  be  obtained.  One  card  should  serve  a  single  worker 
for  as  long  a  time  as  possible,  only  a  single  line  being  used  for  a 
disabiUty  unless  the  patient  is  under  observation  for  some 
time.i 

INDIVIDUAL  RECORD.     FIRST  AID  ROOM 


Nam( 
Rem£ 

irks 

Dept No. . . . 

Case  No 

Date  Hr. 

Disability 

How  injured 

Disposition  or 
Treatment 

Dates  for  redressings,  visits  to 
Doctor,  remarks 

The  opposite  side  should  be  ruled  and  have  column  head- 
ings but  no  top  heading.^ 

The  record  cards  may  be  filed  numerically  or  alpha- 
betically; if  alphabetically,  an  accession  book  will  be  required 
for  Usting  new  cases,  whether  new  individuals  or  additional 
occurrences  to  former  patients;  if  numerically,  an  alpha- 
betical index  should  be  kept.    By  either  of  these  methods  the 

1  A  code  for  writing  up  cards  is  easily  devised  and  is  useful  in  saving 
space  as  well  as  for  making  the  interpretation  of  the  entries  impos- 
sible for  one  who  lacks  the  key.  The  common  hazards  may  each  be 
given  a  number,  the  common  treatments  a  letter,  departments  a 
Roman  numeral,  etc. 

^  The  cards  should  be  a  standard  size,  at  least  5  in.  X  8  in. 


94  INDUSTRIAL  NURSING 

total  number  of  all  cases  may  be  found  for  any  given  time. 
The  sum  found  in  this  way  will  prove  or  disprove  the  cor- 
rectness of  many  a  report. 

A  signal  system  of  colored  tags  or  crayon  marks  at  the 
top  of  the  cards  will  serve  to  classify  them  so  that  the  total 
of  any  desired  group  may  be  obtained.  Another  way  is  to 
have  a  supply  of  cards  of  different  colors,  and  guide  cards. 
The  name  and  identification  of  the  worker  together  with  the 
item  to  be  classified  is  written  on  a  card  and  is  filed  in  its 
proper  place. 

Suppose  it  were  desired  to  discover  at  what  hour  of  the 
day  the  greatest  number  of  injuries  occurred.  The  cards 
should  state  date,  day,  name,  department  and  number,  kind 
of  injury  and  time.  The  guide  cards  would  be  marked  with 
the  time  as  follows:  7  to  7.30;  7.30  to  8;  8  to  8.30,  etc.  After  a 
number  of  years  such  a  record  would  yield  material  for  an 
accurate  report  of  the  incidence  of  industrial  injury  as  af- 
fected by  time  of  day,  day  of  week,  occurrence  of  hoHday, 
season  of  year. 

By  means  of  these  cross  references,  reports  may  be  made,  if 
desirable,  of  the  comparative  number  of  accidents  in  the 
different  departments,  the  prevalence  of  certain  illnesses  in 
certain  occupations,  the  comparative  prevalence  of  injury 
under  different  speeds  in  similar  processes  or  afly  special  mat- 
ter about  which  the  management  is  curious  or  which  will 
help  the  nurse  to  point  an  argument.  Elaborate  records  and 
reports  require  the  attention  of  skilled  clerks,  but  many  little 
studies  may  be  made  by  the  nurse  alone  which  will  prove  a 
point  even  though  the  requirements  of  the  firm  do  not  call 
for  extensive  record  keeping.  Any  one  with  experience  in 
industry,  or  even  with  a  little  imagination,  will  need  no  argu- 
ment as  to  the  need  and  the  uses  of  records  in  industrial 
nursing. 

In  keeping  the  records  it  is  needful  to  guard  against  the  red 
tape  which  may  defeat  their  purpose.  In  one  plant  the  re- 
quirement that  a  worker,  before  applying  for  first  aid,  must 
have  a  long  paper  filled  out  by  his  superior  and  that  he  must 


RECORDS  AND  REPORTS  95 

give  a  good  deal  of  personal  history  before  being  attended  to, 
reduced  the  number  applying  for  first  aid  from  an  average  of 
forty  to  an  average  of  ten  a  day.  The  number  of  infections 
increased  at  once.  When  the  rule  was  changed  the  number 
applying  for  first  aid  became  normal  and  the  number  of 
infections  was  at  once  reduced.  The  records  made  it  possible 
for  the  nurse  to  point  out  the  folly  of  making  first  aid  a 
burden.  The  main  thing  is  that  the  nurse  should  be  accessible 
and  that  the  workers  should  feel  that  they  are  welcome. 
Information  required  for  records  may  be  obtained  in  many 
cases  during  a  casual  conversation  at  the  fii-st  interview.  It 
might  better  not  be  obtained  at  all  than  that  the  worker 
should  feel  that  anything  exceeded  in  importance  his  own 
troubles. 

Some  nurses  with  a  statistical  turn  of  mind  might  be  in- 
clined to  overdo  the  matter  of  records,  but  the  common 
tendency  is  quite  the  other  way.  Most  nurses  are  so  busy 
that  they  are  likely  to  neglect  the  record  in  favor  of  imme- 
diate service  to  the  human  being. 

It  is  not  enough  to  do  the  day's  work.  Findings  in  the 
first  aid  room  and  in  the  homes  should  be  checked  up  in  the 
employment  office  with  time  lost  and  labor  performed  by  the 
worker  and  in  the  statistical  department  for  the  preparation 
of  comparative  studies  of  different  departments  of  the  plant. 

Reports — Daily,  Monthly,  Annual: — In  estabhshments 
where  the  nurse's  records  are  tabulated  and  interpreted  in 
another  department,  or  where  the  nurse  is  employed  by  an 
organization  of  workers  and  where  she  is  not  the  secretary  of 
that  organization  and  the  records  are  kept  in  the  office  of  the 
benefit,  mutual  aid  or  other  association,  daily  reports  of 
nursing  work,  either  in  the  plant  or  in  the  homes,  are  often 
desirable.  An  employer  will  sometimes  wish  such  a  report 
solely  for  his  own  interest.  The  copying  of  daily  records  is 
unnecessary.  If  the  daybook  is  arranged  with  duplicate 
pages  and  carbon  paper,  the  original  sheet,  if  carefully 
written,  will,  with  a  summary  of  the  different  totals  at  the 
bottom,  answer  every  purpose.    When  this  use  is  to  be  made 


96  INDUSTRIAL  NURSING 

of  the  daybook,  care  should  be  taken  in  planning  it  that  there 
is  space  for  all  information  desired  both  by  the  nurse  and  by 
the  other  interested  departments.  Patients  calling  on  the 
nurse  for  advice  in  personal,  confidential  matters  may  be 
listed  without  detail  as  "Personal." 

The  following  is  a  monthly  report  ^  from  a  plant  in  a  small 
town  where  local  public  health  agencies  were  lacking  or 
undeveloped  and  where  a  good  deal  of  public  health  work  was 
done  by  the  industrial  nurses,  who  hved  in  a  nursing  center, 
attended  to  the  first  aid  work  in  the  plant  under  the  direction 
of  physicians,  and  carried  on  visiting  nursing  under  the  aus- 
pices of  the  employes'  benefit  association  and  under  the  di- 
rection of  the  family  physicians  of  the  patients. 

The  work  at  the  nurse's  residence  was  confined  to  nursing 
activities,  the  town  being  well  equipped  with  other  social, 
educational  and  recreational  facihties. 

The  yearly  report  may  be  easily  made  up  from  the  monthly 
reports.  At  regular  but  not  too  frequent  intervals,  every 
three  or  six  months  or  yearly,  a  nonstatistical  report  affords 
an  opportunity  to  take  account  of  progress  or  lack  of  prog- 
ress, to  search  for  hampering  conditions  and  to  point  out 
possible  means  for  improving  the  usefulness  and  efficiency 
of  the  nursing  service.  Such  an  account  of  work  done  or 
contemplated  will  do  much  to  keep  the  nursing  department 
from  stagnation,  the  nurse  from  possibly  unwarranted  self- 
satisfaction  and  cannot  be  wholly  without  interest  to  the 
employer. 

1  In  the  monthly  report  illustrated,  columns  2,  3,  4,  6,  7,  8,  9,  and  11 
are  filled  in  by  the  nurse;  Columns  1,  5,  10  and  12  are  proinded  by  the 
employment  oflfice  and  by  the  office  of  the  Mutual  Aid  Society. 


RECORDS  AND  REPORTS 


97 


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O        O 


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^    a:    a;    2; 


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T(<  IN  ro  ^  lO  CO  ^  ■-<  lO -^  CC  O)  Tjt       .-cINN       ^ 


.yjig'  Mqiunj^i 


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MN       1-1  Til  .-I  t~  CO  Ol  "-I  IN  <N  CO  "-I 


(/iryj)  sj^^xo/^ 


(Nt^OUSOCOOfMiHi-HOiHOOOOOOOO 


II  i(t^a 


■3/3 
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spflojdtu^  Of 


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00— <OC<liOCO-<'^00-H'-i'-<COOCO-*'N<0  —  (N    3   i-i 
ioONcocococnococ^cOTi<cio<N<M.-ii-Hr~        "-i  lo 

lOCO        (NCOIN        Tl< -H  IN  CO  IN  CO  "-IrH        rH  ^    rH 


<5fe^fii,£5[ii<;fii<;&H^fi<<(iH<5fer<fa^Et( 


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CM— I 


98  INDUSTRIAL  NURSING 

The  number  of  interesting  and  useful  ways  of  presenting 
information  easily  obtainable  from  well-kept  industrial  nurs- 
ing records  is  large.  The  writer  has  only  tried  to  point  out  a 
few  possibilities.  A  thoughtful  nurse  in  any  industry  will 
see  numberless  ways  of  using  her  records,  not  only  for  her  own 
information  and  benefit,  but  for  the  benefit  of  worker  and 
employer  as  well. 

The  Records  of  the  Visiting  Industrial  Nurse: — The  records 
of  the  home  visiting  should  be  closely  coordinated  with 
those  of  the  first  aid  room  and  with  the  employment  office, 
where  cooperation  with  that  department  is  allowed.  A 
description  of  a  system  of  combined  records  for  the  use  of  the 
industrial  nurse  who  is  also  in  charge  of  the  employment 
office  will  be  found  in  the  next  chapter.  Where  all  the 
records  of  each  worker  cannot  be  filed  together,  the  visiting 
nurse  can  easily  modify  any  good  system  in  use  by  a  visiting 
nurse  association,  or  that  advocated  by  the  National  Or- 
ganization for  Public  Health  Nursing,  to  suit  her  needs. 

The  visiting  nurse  will  need  a  daybook  in  which  to  record 
the  story  of  each  day.  A  duplicate  page  book  is  useful  and 
time  saving.  The  original  sheet  may  be  used  by  the  person 
responsible  for  writing  up  the  cards  and  may  afterwards  be 
sent  to  the  person  wishing  a  daily  report,  while  the  duplicate 
remains  as  a  record.  Bedside  notes  for  use  in  the  patient's 
home  in  recording  the  orders  of  the  physician,  the  condition 
of  the  patient  and  the  work  of  the  nurse  must  not  be  forgot- 
ten. Where  written  orders  for  the  care  of  the  patient  can  be 
obtained  it  is  wise  to  preserve  them  on  file  in  their  original 
form,  with  the  other  papers  concerning  the  patient. 


CHAPTER  XI 

THE    INDUSTRIAL    NURSE    AND    THE    EMPLOYMENT    OFFICE 
RECORDS 

Employment  management  offers  a  field  of  service  for  women 
in  which  their  peculiar  fitness  is  being  increasingly  recognized. 
It  is  an  opportunity  for  the  nurse  who  has  had  experience  in 
industry.  Close  connection  with  the  "hiring  and  firing" 
of  a  large  establishment,  and  personal  interviews  with  ap- 
plicants for  employment — with  the  nurse's  opportunities 
for  getting  a  full  home,  health,  work  and  educational  picture 
of  the  worker — and  a  system  of  interviewing  all  who  leave, 
will  reveal  much  avoidable  inefficiency  with  consequent 
lessening  of  production.  Causes  for  the  dissatisfaction  of 
employes  are  found  and  resulting  needless  "labor  turnover" 
is  reduced.  Employment  managers  throughout  the  country 
are  succeeding  in  reducing  this  labor  turnover  and  in  in- 
creasing the  efficiency  and  contentment  of  the  workers,  so 
benefiting  both  them  and  the  industry.  Nurses,  as  well  as 
other  educated  women,  are  fiJling  such  positions  and  should 
continue  to  fill  them  in  increasing  numbers,  especially  in  the 
industries  where  many  women  and  girls  are  employed. 

Service  in  the  employment  office,  either  as  manager  or  as 
assistant  manager,  is  a  logical  development  of  the  earlier 
and  better  known  contributions  of  the  nurse  to  industrial 
welfare.  Her  earlier  contacts  with  industry  aid  her,  if  she 
is  otherwise  prepared  for  her  new  duties,  in  becoming  an 
employment  manager  of  exceptional  value.  Courses  of 
study  in  preparation  for  this  work  are  being  offered  in  several 
colleges.  Lacking  a  special  theoretical  training,  a  nurse, 
serving  an  apprenticeship  in  a  well-managed  and  successful 
employment  department  as  assistant  or  otherwise,  would 
gain  an  insight  into  the  necessary  procedures  and  records 

99 


100  INDUSTRIAL  NURSING 

which,  in  addition  to  a  familiarity  with  industry  already  ac- 
quired, should  enable  her  to  assume  the  control  of  such  a 
department. 

The  work  of  employment  management,  as  understood  in 
most  modern  organizations,  includes  much  that  has  been 
known — sometimes  to  its  disadvantage  in  the  estimation  of 
the  worker — as  welfare  work  or  welfare  supervision.  Such  a 
department  is  now,  more  accurately,  frequently  called  a 
service  department.  While  its  main  function  is  to  provide 
for  the  plant  a  sufficient  number  of  healthy  (or  sufficiently 
healthy)  and  contented  employes  who  are  fitted  to  do  the 
work  required  in  an  efficient  manner,  a  secondary  function 
is  to  reduce  the  labor  "turnover"  and  the  resulting  expense 
of  training  new  workers  with  their  increased  Uability  to  in- 
dustrial injury.  The  conception  of  the  work,  however,  as 
held  by  many  employment  managers  is  that  of  a  public 
service  to  the  community,  and  its  opportunities  quite  justify 
them  in  holding  such  an  ideal. 

In  those  plants  so  fortunate  as  to  have  a  physician  in  con- 
stant attendance,  his  work  will  naturally  be  closely  associ- 
ated with  that  of  the  employment  department.  In  such  a 
wide  reaching  medical  department,  the  industrial  nurse  is 
of  special  value  in  the  employment  office  as  assistant  to  the 
physician  in  his  interviews  with  the  patients,  in  the  proper 
recording  of  his  findings  and  in  the  many  other  ways  in  which 
a  nurse  is  accustomed  to  aid  a  physician. 

At  the  present  time  nurses  are  more  frequently  working 
at  employment  problems  in  small  establishments  where 
there  is  no  separate  employment  manager.  A  more  or  less 
informal  employment  department  is  sometimes  developed 
in  connection  with  the  already  existing  nursing  service.  Any 
plant,  where  the  physical  examination  of  employes  by  a 
physician  is  not  a  routine  measure,  will  gain  in  the  health  of 
the  workers  and  in  their  contentment  and  efficiency,  to  say 
nothing  of  freedom  from  claims  (})  for  injuries  which  oc- 

^  Honest  persons  have  been  known  to  be  unconscious  of  defects  until 
attention  was  called  to  them  by  some  accident.    Men  have  been  found 


NURSE  AND  EMPLOYMENT  OFFICE        101 

curred  elsewhere,  by  the  help  of  a  nurse  in  the  employment 
of  new  workers. 

The  consideration  of  a  large  employment  office  will  not 
be  attempted,  A  nurse  contemplating  the  management  of 
such  a  department  would  either  grow  into  it  from  a  small 
beginning  or  should  take  steps  to  prepare  herself  for  the  work. 

While  the  first  thought  might  be  that  the  employment 
department  will  select  workers,  the  truth  is  that  selection 
of  workers  is  now  largely  a  thing  of  the  past,  along  with  our 
former  stream  of  immigration.  Fortunately  for  those  who 
seek  work,  and  indeed  for  the  employer  also,  the  problem, 
in  these  days,  is  often  fitting  the  applicant  to  the  work  which 
must  be  done  or  even  fitting  work  to  the  applicant.  This 
means  ceaseless  instruction  and  a  large  outlay  of  actual 
money  in  the  acquisition  of  each  new  employe.  By  the  exer- 
cise of  judgment  and  the  use  of  records  in  the  employment 
office,  it  is  possible  to  do  much  toward  retaining  good  em- 
ployes and  toward  fitting  new  ones  to  their  work.  Some  firms 
make  it  a  practice  not  to  refuse  employment  to  any  one  ca- 
pable of  doing  work,  except  where  the  presence  of  infection 
or  the  existence  of  epilepsy  would  render  such  employment 
dangerous.  Many  employers  are  willing  to  go  to  a  good  deal 
of  trouble  to  assist  an  applicant  in  overcoming  his  handicap 
or  in  finding  a  cure  for  his  disease.  Furthermore,  it  is  being 
recognized  that  certain  handicaps  are  attended  by  no  dis- 
advantages in  some  occupations.  Deafness  often  helps  at- 
tention when  the  work  demands  close  application.  There 
are  occupations  in  which  even  the  blind  excel,  such  as  work 
requiring  sensitive  touch  rather  than  keen  eyesight.  Even 
years  are  not  the  disadvantage  they  were  considered  for 
some  time  after  Dr.  Osier's  unfortunately  misunderstood 
remark.  Women  of  mature  years  and  high  character  have 
a  steadying  influence  on  the  girls  with  whom  they  work, 
and  are  found  to  be  a  distinct  force  in  making  undesirable 

who  were  blind  in  one  eye  and  who  had  no  idea  of  the  fact  until  told 
by  the  examiner.  Defects  of  hearing  in  one  ear  may  entirely  escape 
notice.  An  explosion  might  cause  such  a  person  to  assign  it  as  the 
cause  of  a  defect  of  long  standing. 


102  INDUSTRIAL  NURSING 

women  uncomfortable  in  the  company  of  those  of  better 
morals  and  in  causing  their  quiet  elimination  from  the  plant. 
Old  men  have  had  a  chance  to  show  that  they  have  quali- 
ties lacking  in  younger  people  and  have  reentered  industry 
in  considerable  numbers  since  war  demands  have  taken  so 
many  of  the  younger  men. 

Now  that  so  many  of  our  soldiers  and  sailors  are  returning 
to  civil  life  maimed  and  crippled,  patriotic  employers  every- 
where are  searching  for  suitable  positions  for  the  handi- 
capped. The  industrial  physician  and  nurse  help  to  dis- 
charge the  debt  of  the  nation  when  they  make  it  possible 
for  one  of  these  young  men  to  take  up  again  a  useful  life  of 
productive  labor. 

The  possibilities  of  service  from  handicapped  labor  are 
understood  but  by  a  few  at  present.  Mr.  F.  B.  Gilbreth 
by  his  motion  studies  is  doing  much  to  promote  a  knowledge 
of  the  necessary  movements  to  perform  certain  actions,  but 
so  far  but  a  comparatively  small  number  know  of  his  work. 
He  has  suggested  that  a  dental  nurse  (an  occupation  which 
he  proposed  to  relieve  the  more  highly  trained  dentist  of 
simple  work  such  as  cleaning  teeth)  can  be  deaf,  one-eyed, 
one-armed  and  legless  and  yet  be  efficient.^  It  requires  little 
imagination  to  conceive  that  a  traffic  officer  may  be  one-eyed, 
one-armed,  and  legless  without  materially  interfering  with 
his  work.  Frequently  a  very  simple  appliance  or  change  in 
the  form  of  an  implement  will  enable  a  cripple  to  do  quite 
complicated  work.  Through  the  publication  of  pictures  of 
crippled  soldiers  at  work  this  knowledge  is  becoming  more 
general.  A  number  of  examples  are  illustrated  in  Dr.  W.  R. 
Dunton's  "Reconstruction  Therapy,"  Chapter  XI,  Pros- 
thetic Appliances. 

The  fact  that  a  worker  is  conspicuously  handicapped  will 
frequently  urge  him  to  every  effort  to  show  his  appreciation 
of  the  consideration  given  him.  When  the  applicant  suffers 
from  a  curable  trouble  advice  rather  than  material  relief 

1  A  New  Occupation  for  the  Crippled  Soldier — The  Conservation  of 
the  World's  Teeth.    Trained  Nurse  and  Hospital  Review. 


NURSE  AND   EMPLOYMENT  OFFICE       103 

will  often  make  it  possible  for  a  formerly  inefficient  worker 
to  hold  a  good  "job."  Service  of  this  kind  need  not  mean  a 
large  expenditure  for  the  actual  care  of  strangers.  Until  the 
state  assumes  responsibility  for  the  health  of  everyone,  it 
must  continue  to  be  the  duty  of  all  who  are  in  a  position 
to  discover  the  physical  shortcomings  of  others  to,  at  least, 
suggest  the  first  steps  necessary  in  the  search  for  health. 

Inquiry  into  the  previous  education  and  experience  of 
applicants,  instead  of  giving  them,  without  question,  the 
work  for  which  they  ask,  will  often  discover  good  workers 
for  a  much  higher  grade  of  labor.  High  school  graduates 
have  been  found  running  errands  while  the  office  force  needed 
clerks  and  while  young  people  were  wanted  to  train  for  good 
positions. 

Numerous  psychological  tests  are  in  vogue  for  discovering 
the  mental  capacity  of  workers  with  a  view  to  aiding  their 
advancement.  Some  employment  managers  use  such  tests, 
but  the  proper  interpretation  of  the  results  is  of  so  technical 
a  nature  that  their  usefulness  is  questionable  unless  employed 
by  a  psychologist.^ 

The  initial  interview  with  the  applicant  by  the  nurse  will 
attain  many  desirable  results.  Findings  made  permanently 
available  in  the  records  will  be  of  daily  use  in  making  changes 
in  the  force  to  allow  for  the  varying  demands  of  the  different 
departments.  They  will  show  which  workers,  not  required 
in  one  department,  can  be  made  available  for  the  different 
duties  of  another  department,  temporarily  busier,  thus  avoid- 
ing the  practice,  wasteful  both  to  the  employer  and  to  the 
employe,  of  laying  off  workers  in  one  section  while  advertising 
for  help  in  another. 

Strange  surroundings  are  less  confusing  when  the  worker  is 
met  by  a  responsible  person  whose  business  it  is  to  see  that 
he  has  some  one  to  teach  him  his  new  duties,  explain  to  him 
the  provisions  made  for  his  safety  and  comfort,  together  with 

*  "There  is  as  yet  no  secure  scientific  method  of  testing  applicants." 
"Industrial  Loyalty,  its  Value,  its  Creation,  its  Preservation,"  Boyd 
Fisher. 


104  INDUSTRIAL  NURSING 

the  precautions  expected  of  him,  and  who  puts  him  in  charge 
of  another  worker  who  will  take  him  to  the  lunch  room  at 
noon  and  introduce  him  to  some  of  his  future  associates. 

The  nurse,  as  employment  manager  or  working  in  the  em- 
ployment office,  should  learn  the  particular  needs  of  the 
workers.  She  should  learn  as  much  as  possible  of  the  proc- 
esses at  which  women  and  girls  work  and  should  be  able  to 
state  accurately  if  they  involve  too  much  strain,  and  show 
why  such  is  the  case.  She  should  understand  the  work  re- 
quired of  the  men  and  the  boys.  Without  this  knowledge 
she  will  make  mistakes  in  placing  workers  and  she  will  not 
be  able  to  speak  convincingly  in  her  efforts  at  adjustment. 
The  nurse  employment  manager  or  assistant  employment 
manager  may  be  expected  to  be  responsible  for  the  general 
behavior  of  the  women  and  girls  except  in  the  technical  de- 
tails of  their  work.  She  may  be  expected  to  look  after  the 
maintenance  of  healthful  conditions  in  the  plant  as  to  cleanli- 
ness, light,  warmth,  ventilation,  moisture,  etc.,  by  keeping 
the  management  informed  as  to  her  observations. 

In  some  plants  a  representative  of  the  employment  office 
calls  at  the  home  of  each  new  worker,  especially  young  people, 
in  order  to  make  the  acquaintance  of  the  parents  and  to  pro- 
mote mutual  friendship  and  helpfulness.  The  industrial 
nurse,  in  the  employment  office  as  well  as  in  the  first  aid 
room,  should  be  able  to  provide  information  to  workers  as 
to  housing,  boarding  and  rooming  places  for  men  and  women, 
hospital  and  dispensary  facilities,  night  schools,  day  nurser- 
ies, means  of  transportation  and  many  other  matters  which 
will  appear  in  her  daily  contact  with  the  workers. 

There  should  be  opportunities  to  study  the  health  of  the 
workers  in  relation  to  their  efficiency.  If  the  management 
will  allow  the  nurse  to  keep  in  touch  with  the  paymaster's 
department,  she  can  watch  the  wage  sheets  of  the  workers 
and  will  often  find  a  steady  decrease  of  earnings  an  early 
indication  of  failing  health.  With  information  obtained  from 
the  timekeepers  the  nurse  in  the  employment  office  of  a 
small  plant  or  through  the  visiting  nurse  of  a  large  organiza- 


NURSE  AND  EMPLOYMENT  OFFICE        105 

tion  will  be  able  to  point  out  inadequate  means  of  transporta- 
tion, unreasonable  distances  to  be  traveled  and  many  other 
matters  which  might  be  adjusted  for  the  benefit  of  the  work- 
ers if  the  employer's  attention  were  called  to  the  exact  need. 
A  report  from  the  industrial  visiting  nurse  of  the  necessary 
expense  of  living  was  known  to  cause  one  employer  to  raise 
materially  his  minimum  wage. 

The  industrial  nurse  must  not  be  exploited  in  the  dismissal 
of  employes.  If  she  finds  the  physical  condition  of  the  worker 
such  as  to  make  rest  advisable,  she  should  be  able,  with  the 
cooperation  of  the  family  doctor  and  the  worker's  family  or 
friends,  to  advise  or  assist  the  sick  person  to  get  proper 
medical  care  and  to  make  it  possible  for  him  to  take  the 
necessary  treatment.  IMost  workers,  who  see  what  seems  to 
them  a  practical  way  of  overcoming  their  ill  health,  are  willing 
to  stop  work  and  to  make  the  effort  to  get  well.  The  nurse 
can  arrange  matters  with  these  workers  so  that  resignation 
will  be  voluntary,  reemployment  depending  on  improved 
physical  condition. 

No  dismissal  of  an  employ^  for  cause  or  for  the  reduction 
of  force  should  be  miputed  to  the  nurse.  This  must  be  con- 
tinually guarded  against.  Foremen  wishing  to  get  rid  of  a 
worker  mil  sometimes  unthinkingly  involve  the  nurse,  with 
no  real  reason  for  doing  so.  If  the  nurse  has  been  instru- 
mental m  proving  the  inadvisability  of  the  continued  em- 
ployment of  any  worker,  justice  to  the  worker  and  to  the 
nurse  demands  that  she  have  an  opportunity  to  talk  with 
the  employe  and  make  plain  to  him  just  why  other  work 
will  suit  him  better.  No  worker  should  be  turned  away 
without  being  made  to  feel  that  sympathetic  consideration 
has  been  given  him  and  that,  if  he  were  suited  to  the  employ- 
ment, he  would  like  to  work  for  a  company  showing  him  such 
kindness.  Neither  should  a  worker  or  applicant  be  turned 
away  without  thought  as  to  his  next  "job."  If  no  work  can 
be  found  in  the  plant  for  an  applicant,  he  should  be  told  if 
possible  where  to  apply  for  employment.  It  may  even  be 
worth  while,  in  some  instances,  to  find  a  position  for  him. 


106  INDUSTRIAL  NURSING 

With  the  development  of  noncommercial  local,  state  and 
federal  employment  bureaus,  it  is  becoming  easier  in  many 
locaUties  to  place  applicants  for  work  where  they  will  be 
able  to  use  their  talents  to  their  best  personal  advantage. 

An  interview  with  each  departing  employe  is  important 
in  order  to  obtain  a  record  of  why  he  thinks  he  is  discharged 
so  that  comparison  may  be  made  with  the  reasons  given  by 
those  discharging  him.  This  also  affords  an  opportunity 
to  discover  why  the  worker  who  leaves  of  his  own  accord  is 
dissatisfied  with  his  "job."  Much  tact  is  sometimes  required 
to  get  this  information,  but  the  findings  are  often  well  worth 
recording  and  tabulating. 

The  industrial  nurse,  in  the  employment  office,  first  aid 
room  or  visiting  in  the  homes,  who  gives  and  obtains  good 
cooperation  should  have  through  her  records  something  of 
value  to  offer  in  the  study  of  the  relation  of  hours  of  work 
and  of  fatigue  to  illness  and  to  injury  as  well  as  to  output; 
in  the  effect  of  speeding-up  on  the  number  of  injuries  and 
on  the  endurance  of  the  workers;  in  showing  the  economic 
and  health  value  of  proper  lunches  and  of  regular  periods  of 
rest;  in  pointing  out  the  consequences  of  the  employment  of 
expectant  mothers  and  of  mothers  of  little  children,  es- 
pecially with  regard  to  the  prevalence  of  miscarriage  and 
infant  mortahty ;  as  well  as  in  searching  out  the  less  obvious 
health  and  accident  hazards. 

The  record  cards  and  blanks  illustrated  are  in  actual  use 
by  nurses  working  in  connection  with  the  employment  of 
labor.  They  will  prove  suggestive  to  one  who  must  devise 
such  conveniences  and  who  has  no  precedent  in  beginning 
a  record  system.  The  forms  shown  are  specially  adapted 
to  the  needle  trades  and  will  require  modification  for  any 
plant.  If  all  the  cards  are  uniform  in  size  they  may  be  filed 
together  during  the  employment  of  the  worker. 

The  description  of  other  printed  matter  is  also  intended  to 
be  merely  suggestive,  some  plants  requiring  few  forms  and 
others  with  many  departments  having  entirely  different 
needs.    The  industrial  nurse  beginning  alone  or  with  little 


NURSE  AND   EMPLOYMENT  OFFICE        107 

assistance  should  guard  against  a  multiplicity  of  forms  and 
blanks  which  cannot  be  properly  used  for  lack  of  time.  It 
is  easier  to  ask  for  additional  forms  when  their  need  is  evi- 
dent than  to  explain  why  a  large  number  of  blanks  provided 
in  the  beginning  have  not  been  used. 

The  outline  for  the  first  interview,  while  suggestive,  will 
probably  be  exactly  suited  only  to  the  plant  for  which  it  was 
devised.  The  outline  for  the  observation  of  the  physical 
condition  of  the  applicant  by  the  nurse  is  in  no  sense  intended 
to  supplant  a  medical  examination  by  a  physician.  It  is 
merely  a  guide  to  the  observation  of  conditions  which  might 
indicate  consultation  with  the  physician  in  those  plants  not 
providing  medical  examination  of  all  applicants  as  a  matter 
of  general  poHcy. 

The  observation  of  the  physical  condition  of  an  applicant 
need  not  be  very  prolonged.  Much  may  be  observed  while 
talking  to  the  person.  If  the  nurse  explains  as  she  proceeds 
that  the  eyes  are  examined  so  that  the  applicant  may  not 
be  given  work  injurious  to  defective  eyes,  that  the  ears  are 
examined  to  make  sure  that  the  worker  is  able  to  hear  sig- 
nals in  connection  with  his  work  and  if  the  nurse  has  a  reputa- 
tion for  being  able  and  anxious  to  help  people,  there  will  be 
few  if  any  who  will  object  to  this  interest  in  their  welfare. 
In  this  field  as  in  all  others  the  nurse  should  carefully  guard 
her  reputation.  Opinion  is  easily  formed  and  hard  to  change. 
Years  of  thoughtful  care  and  work  for  others  may  not  enable 
one  to  entirely  hve  down  even  one  hasty  and  ill  considered 
act. 

Care  in  observing  the  symptoms  of  weak  arches  and  in 
finding  varicose  veins  is  of  importance  in  assigning  em- 
ployes to  work  which  requires  much  standing.  Proper  sup- 
port for  a  part  of  the  time  with  suitable  exercises  or  other 
treatment  should  make  the  flatfooted  more  able  to  do  general 
work  and  the  afflicted  applicant  should  be  told  the  im- 
portance of  seeking  a  skilled  practitioner  for  diagnosis  and 
advice. 

The  many  people  who  suffer  from  varicose  veins  and  who 


108  INDUSTRIAL  NURSING 

have  no  idea  of  how  to  care  for  them  is  surprising.  Once  the 
opinion  of  a  surgeon  has  been  obtained  and  it  is  decided 
that  support  only  is  indicated,  the  care  of  such  sufferers  is 
surely  work  for  a  nurse.  There  is  nothing  a  nurse  can  do 
which  will  be  more  appreciated  than  the  teaching  of  those 
having  varicose  veins  how  to  keep  them  supported  while 
standing  or  sitting,  impressing  on  them  the  advantages  of  a 
recumbent  position  whenever  they  are  resting,  and  relieving 
them  of  anxiety  by  instructing  them  as  to  what  should  be 
done  in  case  of  rupture  or  if  an  ulcer  should  appear. 


NURSE  AND  EMPLOYMENT  OFFICE       109 

APPLICATION  FOR  EMPLOYMENT  ^ 

Blank  and  Company 

9  North  Fifth  St.,  Seneca,  Cal. 


Service  Department  Date 

Name  in  fuU 

Address Telephone  Number 

Place  of  birth Date  of  birth 

Married,  single,  widowed.  .  .  .Do  you  hve  with  parents?. 
Education  (give  details  of  highest  grades  attended) .... 


Do  you  attend  evening  school? 

What  studies  are  you  pursuing? 

Position  desired Salary  expected .  .  . 

Have  you  ever  done  such  work  before? 

Where When Position  held. 

Name  and  address  of  last  employer 


Position  held How  long  employed.  . .  .Salary. 

Date  of  leaving Reasons  for  leaving. .  . 

Name  and  address  of  previous  employer 


Position  held How  long  employed. . .  .Salary 

Date  of  leaving Reasons  for  leaving 

Other  business  experience 

If  we  are  unable  to  give  you  the  position  desired  at  once, 

what  position  will  you  take  temporarily? 

Recommended  by .  .  .  adv. .  .  .  sign ....  employment  bureau 
References:  Names  and  addresses  of  at  least  two,  other 
than  relatives 


Remarks: 

Signed . 


Applicant  interviewed  by 

1  Print  on  card  uniform  in  size  with  other  cards. 


110  INDUSTRIAL  NURSING 

Blank  and  Company 
9  North  Fifth  St.,  Seneca,  Cal. 
Service  Department  Date 


M 

Gentlemen: 

Mr.  Mrs.  Miss has  applied  to  us  for  a 

position    as stating    that was    in 

your    employ    as from    (date) in 

Dept.,     under    Mr Foreman; 

and   that left   (date) Any  informa- 
tion you  may  give  us  regarding will  be  treated  as 

strictly  confidential. 

Was.  .  .  .  employed  by  you  for  the  period  above  stated?. .  .  . 

'  Good? 

Skill  -i  Medium? 

Bad? 

r  Fast? 

Production  \   Medium? 

[  Slow? 

Character? 

At  what  class  of  work  does  applicant  excel? 

Remarks : 


Signed 


Thanking  you  in  advance  in  anticipation  of  a  prompt 
reply,  and  assuring  you  of  our  willingness  to  reciprocate, 
we  are 

Yours  very  truly, 
Blank  and  Company, 
Service  Department. 

Copy  of  application  for  employment  for  filing  in  waiting 
list  and  for  use  as  a  cross  file  after  employment. 

No ....      Service  Department  Date 

Name 

Address Telephone  No 

Age Nationality Single,  Married,  Widowed 

Similar  work  elsewhere? Where? 

What  process? 

Name  and  address  of  last  employer 

Of  previous  employer 

Father's  name Nationality 


NURSE  AND  EMPLOYMENT  OFFICE        111 


Dept PERSONAL  HISTORY  C ARD  i  No . 

Name Citizen? lat  papers 2nd  papers .  . 

Address Telephone  No 

Place  and  date  of  birth 

Relatives  living?    Father Nationality , 

Mother Nationality 

Brothers Sisters Children  (sex  &  ages) , 

Wife Employed Where , 

Hus Employed Where Citizen?.  .  . 

Wage  Earners 


School  Training:  yrs.  in  U.  S yrs.  abroad Grade  in  U.  S 

Date  of  immigration English,  Speaks Reads Writes. 

Religion? 

Societies? 

Last  employer? Why  left? 

Previous  employer? Why  left? 

Assigned  to Dept No 

Operation Wage Date 


HOME:  Live  at? No.  Rooms No.  occupants Boarders. 

Sanitary  condition 

Home  visits  by  nurse  (1st  &  last  at  each  absence) 


Remarks . 


In  case  of  accident  notify 

Possible  transfer  to — Purch.,  Op.,  Stock,  Design.,  Exam.,  Sales,  Cut.,  Trim.,  Press., 
Ship.,  Mach.,  Clerical 


'  Large  cards — 5  in.X  8  in. 


112  INDUSTRIAL  NURSING 

Reverse  side  of  personal  record  card. 


First  Aid  Room        Name                       Dept. 

Date 

Hour 

Disability 

How  injured 

Disposition  or  treatment, 
remarks 

Home  visiting 

Date 

Disability 

Dates  of  visits,  services  rendered,  remarks 

Home  visiting  records  may  be  kept  on  the  reverse  side  of 
the  personal  history  card.  Supplementary  cards  ruled  on 
both  sides  for  first  aid  and  for  visiting  nursing  will  provide 
extra  space. 

Where  the  nurse  is  permitted  to  gather  and  use  the  in- 
formation indicated,  this  card  or  one  modified  to  suit  the 
industry  will  give  a  fair  history  of  the  worker,  with  the 
exception  of  his  attendance  and  work  records,  which  cannot 
be  included  unless  the  management  allows  the  cooperation 
of  the  timekeepers  and  of  those  keeping  the  wage  sheets. 

A  numerical  file  is  necessary  for  filing  the  names  of  the 
workers  by  their  identification  numbers.  This  requires  only 
name,  department  and  number  of  each  worker.  A  daybook 
for  those  applying,  discharged  and  engaged  will  make  possible 
the  making  up  of  monthly  and  weekly  reports  without  tire- 
some sorting  of  cards. 


NURSE  AND   EMPLOYMENT  OFFICE        113 

The  card,  for  the  requisition  of  employes,  states  the  re- 
quirements of  the  department  and  affords  a  record  of  the 
disposition  of  new  and  of  the  transfer  of  old  employes. 
Plate  A. 

A  wage  and  time  card  ruled  on  both  sides  will  give  a  record 
of  the  hours  worked  and  of  the  earnings  of  an  employe  for 
two  years.     Plate  B. 

A  report  devised  to  fit  the  industry  and  affording  the 
information  suggested  in  the  following  form  will  make  possible 
the  comparison  of  different  departments  and  of  the  different 
years  in  the  same  department.     Plate  C. 

An  employer  establishing  or  reorganizing  a  service  de- 
partment may  expect  the  industrial  nurse  to  suggest  forms 
for  other  uses,  such  as  identification  cards  and  passes.  Visit- 
ing cards,  for  the  use  of  a  nurse  visiting  in  the  homes  or 
acting  as  a  representative  of  the  company  in  any  capacity, 
are  almost  a  necessity. 


IDENTIFICATION  CARD  TO  BE  CARRIED  BY 
THE  EMPLOYi: 


Blank  and  Co. 
9  North  Fifth  St.,  Seneca,  Cal. 

Identification  Card 

Name Clock  No 

Address 

Issued 

Height Weight Hair 

Eyes Complexion Beard 

Mustache Signature 

Employe Service  Department 


DEPARTMENT- 


SERVICE  REQUISITION 

DATE 


.  Male 

F 

CMAI  C 

Week  Work 

Piece 

WORK 

Duties- 

Position 

MAXI- 
MUM 
RATE 

RATE 

WISH 

TO   PAY 

HniiDO 

Desired  Qualifications. 

Age  between 

Experience 

Other  points 

Replacinq 


.  Education. 


-Increase  In  Force. 


To  Mr 

Introducing. 


INTRODUCTION 


-DATE. 


FOR. 


Sign. 


If  applicant  Is  satisfactory  Insert  only  the  date  effective  and  rate  and  return  to  Service  Department 
with  signature. 

If  applicant  is  not  satisfactory,  show  reason,  sign  opposite  No.  1  and  return  In  envelope  to  Service 
Department. 


REJECTION  NOTICE. 
Reason  


Signature  1. 


NOTICE 

OF 

1  Engageme 

n             1 

1  Re-Engagemant         | 

1  Re-lnstatflr 

lent          1 

i  Transfer                         1 

ON 

THE 

1   Pr 

ivatg 

Payroll 

1   M 

c'.r.p. 

Payroll 

Name 


Address 


Date.Effective 
Rate 


No^ 


Per 


Departm 

ENT 

Position 

INCREASE 

m  fo«ce 



nCPLACINS 

0I6XI5SE0 

TR.~SrERReO  TO 

OePT.                                                                          t 

AUTHORIZED: 


SERVICE  DEPT. 


DEPT.  MGR.,  FACTORY  MQR. 


Return  to  SERVICE  DEPARTMENT  at  once. 
Plate  A 


DATE 

DATE 

DATE 

DATE 

HOURS 

EARN- 
INGS 

HOURS 

EARN- 
INGS 

HOURS 

EARN- 

INGS 

HOURS 

EARN- 
INGS 

1 

27 

1 

27 

2 

28 

2 

28 

3 

29 

3 

29 

4 

30 

4 

80 

5 

31 

5 

31 

6 

32 

6 

32 

7 

33 

7 

33 

8 

34 

8 

34 

9 

35 

9 

35 

10 

36 

10 

36 

11 

37 

11 

37 

12 

38 

12 

38 

13 

39 

13 

39 

14 

40 

14 

40 

15 

41 

15 

41 

16 

42 

16 

42 

17 

43 

17 

43 

18 

44 

18 

44 

19 

45 

19 

45 

20 

46 

20 

46 

21 

47 

21 

47 

22 

48 

22 

48 

23 

49 

£3 

49 

24 

50 

24 

50 

25 

51 

25 

51 

26 

52 

.      . 

26 

52 

«=.== 

Zt 

vwatn 

Plate  B 


es 
«  t. 

e 


^^  <u 


es 

B 

12 

S  B 


Q  ix; 


■!->  O 


Z     E 


_  b 

u 

fa   B 

O  •- 

S»5 


s 
o 

B 

u 
« 


o 

CO 
Q. 

O 
O 

O 


E 
o 
o 


»-     P     a> 

?  a>  a 

«    ii    O    " 


•F.     •- 


9-    c  -J 


:5     ft)     O     O 
OC    X    O    U 


V) 

CO 

j_ 

q: 

(V 

E 

TO 

0) 

o 

N 

4-* 

a: 

c 

0) 

00 

.i 

TO 

0. 

o 

M 

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H    5 


w 

». 

</) 

E 

« 

o 

lU 

c: 

_ 

3 

3 

Q. 

q: 

</> 

-> 

Plate  C 


NURSE  AND  EMPLOYMENT  OFFICE        117 

PASS 


Blank  and  Co. 
9  North  Fifth  St.,  Seneca,  Cal. 

Pass  Out 191.. 

Name Clock  No at A.  M. 

P.  M. 
Reason 

With  following  articles 

Signed 

Dept 


VISITING  CARD 


MiSB  Jane  A.  Smith,  R.  N. 
Visiting  Nurse 


Secretary 

Mutual   Aid  Society 

Employ^a  of  Blank  and  Co. 


A  printed  list  of  the  conveniences,  comforts  and  special 
advantages  provided  is  sometimes  given  to  each  new  em- 
ploy6. 

BLANK  &  CO.,  9  North  Fifth  St.,  Seneca,  Cal. 

SPECIAL  SERVICE  TO  EMPLOYES  i 

We  desire  to  make  this  establishment  a  most  desirable 
place  to  work  in,  and  to  that  end  we  maintain  a  Service 
Department,  the  object  of  which  is  to  supply  every  com- 
fort, convenience  and  safety  to  our  employes. 

1.  We  have  a  Service  Director,  a  trained  nurse,  who 
devotes  her  entire  time  to  overseeing  our  service  to  em- 
ployes. 

2.  In  cooperation  with  the  City  Pubhc  Schools,  a  class 
is  maintained  at  the  factory  each  day  for  the  purpose  of 
teaching  the  reading  and  writing  of  English  to  those  who 

1  Copied  almost  verbatim  from  a  circular  used  by  Mrs.  Claribell  Hill. 


118  INDUSTRIAL  NURSING 

have  need  for  it.  The  Board  of  Education  supplies  the 
teacher,  and  the  firm  pays  the  girls  for  their  hours  in  our 
school. 

3.  In  cooperation  with  the  City  Board  of  Health,  a 
series  of  health  lectures  is  given  in  the  Recreation  Hall 
at  the  noon  hour. 

4.  A  first  aid  room  is  provided  for  employes  who  are 
sick  during  business  hours,  with  a  trained  nurse  in  attend- 
ance. 

5.  A  trained  nurse  visits  sick  employes  in  their  homes  if 
necessary. 

6.  The  Service  Director  may  be  called  upon  confiden- 
tially for  aid  or  advice  in  personal  matters. 

7.  A  lunch  room  is  provided  where  employes  may  pur- 
chase wholesome  food  at  cost  prices. 

8.  A  Recreation  Hall  is  provided.  Dancing  and  music 
are  enjoyed  here  during  the  noon  hour.  A  piano  and  pho- 
nograph have  been  installed  for  that  purpose. 

9.  A  free  circulating  library,  a  branch  of  the  City  PubUc 
Library,  is  maintained  for  the  convenience  of  employes. 

10.  Current  magazines  will  be  found  on  the  tables  m  the 
Recreation  Hall. 

11.  Librettos  and  books  on  the  operas  may  be  bor- 
rowed when  desired. 

12.  Special  entertainment  is  furnished  from  time  to  time 
at  the  noon  hour. 

13.  A  dancing  class  is  in  session  one  noon  a  week  where 
modem  social  dancing  is  taught. 

14.  Lectures  are  given  twice  a  month  at  the  noon  hour 
in  the  Recreation  HaU. 

15.  A  popular  Song  Review  is  held  once  a  week  under 
competent  direction. 

16.  A  gymnastic  class  and  a  class  in  folkdancing  are 
held  once  a  week  at  the  noon  hour  with  a  competent  in- 
structor in  charge. 

17.  Dumb-bells,  wands  and  a  punching  bag  have  been 
placed  in  the  Recreation  Hall,  for  the  use  of  the  employes. 

18.  A  dressmaking  class  is  held  in  the  Recreation  Hall 
one  evening  a  week,  under  the  direction  of  a  teacher.  A 
charge  of  fifty  cents  is  made  for  five  lessons,  equipment 
being  furnished  by  the  firm  and  materials  by  the  pupils. 

19.  A  Vacation  Fund  is  maintained  where  girls  may 
deposit  small  savings  toward  their  vacation  expenses. 

20.  Bulletin  boards  are  placed  throughout  the  factory 
where  notices  and  items  of  interest  are  posted. 

21.  Any  employ^  who  first  suggests  an  improvement  or 
any  feasible  plan  for  economy  of  any  nature  wUl  be  paid 
$2.50  for  each  suggestion  adopted. 

22.  A  supply  of  umbrellas  is  kept  for  the  convenience  of 
employes  which  may  be  rented  for  five  cents  a  day  when- 
ever needed. 


NURSE  AND   EMPLOYMENT  OFFICE        119 

23.  A  supply  of  stockings  is  kept  for  the  convenience 
of  employes  which  may  be  purchased  ,for  ten  cents  a 
pair. 

24.  AH  employes  are  given  the  benefit  of  wholesale  prices 
on  merchandise  bought  for  personal  use. 

25.  A  monthly  paper  is  published  by  and  for  the  em- 
ployes. "Threads  and  Thoughts,"  subscription  price, 
twenty-five  cents  per  year. 

26.  Several  evening  entertainments  are  given  during 
the  year. 

All  Work  of  the  Service  Department  is  Done  by 
Committees  of  the  Employes  in  Cooperation  with 
THE  Service  Director 

Cooperation  means  success. 
Please  be  quiet. 

Do  not  make  unnecessary  noise  in  halls  or  on  stairways. 

Please  be  careful. 

This  is  your  business  home.  Be  careful  of  it  and  keep  it 
clean.    Do  not  mark  or  deface  walls  or  fixtures. 

Please  be  orderly. 

If  you  use  a  thing,  return  it  to  its  proper  place. 

Please  be  reasonable. 

There  are  nearly  600  people  in  this  building  who  have 
the  same  privileges  that  you  have.  Do  not  do  any- 
thing that  would  not  be  right  for  every  one  of  them 
to  do. 

Please  be  clean. 
Do  not  spit  on  floors  or  stairs.    Spitting  in  public  places 
endangers  your  life  and  the  lives  of  your  f eUow  work- 
ers.   It  is  prohibited  by  the  Board  of  Health. 

An  outline  for  the  observation  of  the  physical  condition  of 
the  applicant  for  emplojTiient  follows.  If  the  items  are 
printed  on  a  card  uniform  with  the  other  record  cards  and  if 
the  questions  to  be  answered  by  the  appUcant  are  printed 
no  the  reverse  side,  a  permanent  record  for  filing  is 
provided. 

In  planning  a  card  for  this  purpose,  if  there  is  a  physician, 
other  than  the  family  doctor,  to  whom  the  nurse  is  permitted 
to  send  cases  which  she  thinks  should  be  passed  on  by  a 
doctor,  he  should  be  consulted  and  he  would  imdoubtedly  be 
able  to  make  valuable  suggestions. 


120  INDUSTRIAL  NURSING 


Colored,  White,  Male,  Female  Married,  Unmarried,  Children With  parents 

Name Address Age 

Height Weight Age  on  entering  industry 

T P R Mouth Nose Throat Eyes 

Feet Corns Bunions Swelling Foot  gear 

Legs Scars Varicose  veins Swelling 

(Edema Eyelids Legs Deformaties 

Evidence  of  former  injury  visible 

Eyesight  both r 1 Colorblind 

Hearing   both r 1 f  U.  R.  12345678 

Unsuited  to 'r„„ti,  I  U.  L.  12345678 


•Teeth 


L.R.  12345678. 
L.R.  12345678. 


Remarks . 


Applicant  observed  by Nurse 

Ex.  by  Dr Statement 


Reverse  side  of  card. 


Name Date 

Have  you  ever  had  any  of  the  following  diseases?    Fits 

Lung  trouble Rheumatism Rupture 

What  illnesses  have  you  had? 

Have  you  any  physical  defects? 

Signed Applicant 

Remarks 

Employed Waiting  List Rejected 

For  observation 

To  reapply  after  treatment After  treating  head 

With  proper  shoes Suitable  dress 

Certificate  from  Dr ■ 

Medical  history  after  employment.  Transfers,  etc 


Ear  tests  may  be  made  with  a  "  dollar  watch."  Standard 
cards  for  testing  eyes,  with  instructions  for  their  use,  are 
obtainable  from  dealers  in  optical  supplies  free  of  charge 
or  for  a  small  sum.  Color  blindness  may  be  tested  with 
a  card  of  sample  colors  to  which  the  applicant  matches 
small  bits  of  the  same  colors.  There  should  be  several  shades 
that  do  not  correspond  with  the  primary  and  secondary 


NURSE  AND  EMPLOYMENT  OFFICE        121 

colors  on  the  sample  card.  Those  shades  intended  to  match 
should  match  exactly.  For  workers  who  will  be  expected  to 
match  dehcate  shades  special  tests  will  be  required. 

The  first  interview  with  the  new  employe  is  so  important 
that  an  outline  should  be  prepared  which  may  be  kept  on  the 
nurse's  desk  so  that  nothing  may  be  forgotten. 

Outline  for  the  First  Interview  with  the  New  Em- 
ployI; 

I.  Responsibility  of  the  organization  toward  the  worker: 

1.  Earning  opportunity: 

(a)  Hours  of  work. 

(b)  Minimum  starting  wage. 

(c)  Wage  system  (piece,  rate,  task,  etc.). 

(d)  Basis  of  promotion. 

2.  Regularity  of  employment : 

(a)  Providing  of  work  and  of  exact  positions. 

(b)  Scientific  assignment  of  workers  according 

to  need. 

(c)  Teaching  each  worker  several  occupations. 

(d)  Security  of  position. 

3.  PoHcies  and  methods  of  cooperation. 

(a)  Purpose  of  service  department. 

(1)  Adjustment  of  diflficulties. 

(2)  Cooperation  in  the  development  of 
mental,  physical  and  social  well-being. 

(b)  Purpose  of  instruction  department. 

(c)  Purpose  of  other  departments. 

II.  ResponsibiHty  of  the  worker  toward  the  organization: 
1.  Responsibility    for    the    maintenance    of    proper 
physical  and  moral  conditions: 

(a)  Value  of  neatness  and  order  in  surroundings. 

(b)  Wholesome  moral  atmosphere. 

(c)  Plain  business  dress  and  courteous  manner. 

(d)  Democratic  spirit. 


122  INDUSTRIAL  NURSING 

2.  Regularity  of  attendance: 

(a)  One  worker  for  each  position. 

(b)  Care  of  health  with  the  aid  of  factory  med- 

ical department.    First  aid,  visiting  nurse, 
etc. 

(c)  Importance  of  home  hygiene. 

(d)  Importance   of   the    avoidance   of   outside 

work. 

(e)  Importance  of  regular  hours  and  wholesome 

recreation. 

III.  The  importance  of  character: 

(a)  Essential  to  fitness  and  advancement. 

(b)  Reasons  for  giving  proper  notice  when  quitting 

(bonus  for  notice). 

(c)  Necessity  for  being  patient  and  reasonable  and  for 

giving  work  a  fair  trial. 

(d)  Frankness  and  promptness  in  presenting  com- 

plaints and  criticisms.^ 

The  correspondence  of  an  employment  office  or  of  the 
nurse's  ofiice  should  be  carefully  filed.  A  convenient  method 
for  keeping  the  letters  and  other  papers  concerning  any  one 
employe  with  his  other  records  is  by  means  of  a  heavy  manilla 
envelop  of  a  size  to  match  the  record  cards,  having  printed 
across  the  eight-inch  side  a  space  for  the  name,  department 
and  number  of  the  worker.  Where  there  are  papers  to  be  filed 
for  only  a  few  of  the  employes  this  method  is  sufficient. 
Where  there  are  many  papers  for  each  sick  worker,  as  when 
the  visiting  nurse  delivers  the  sick  benefits  and  keeps  receipts, 
the  envelop  may  be  printed  on  both  sides  like  the  form  for 
lower  part  of  the  reverse  side  of  the  personal  history  card. 
The  outside  of  the  envelop  may  then  be  used  for  visiting 
nurse  records. 

1  This  outline  for  the  first  interview  with  the  new  employ^  is  taken 
almost  verbatim  from  an  address  by  Miss  Mary  Gilson,  delivered  at 
the  Employment  Managers  Conference,  Philadelphia,  Pa.,  April  2  and 
3,  1917.  Bulletin  of  the  United  States  Bureau  of  Labor  Statistics, 
Number  227. 


NURSE  AND  EMPLOYMENT  OFFICE        123 

The  employment  department  must  be  "  built  on  a  founda- 
tion of  records  ";  the  system  must  be  just  elaborate  enough  to 
give  a  complete  picture  of  each  worker  and  no  more.  The 
simpler  the  files  the  less  chance  of  misfiling.  A  misfiled  record 
may  almost  as  well  be  lost.  The  records  must  be  kept  up  to 
date  as  to  the  disposition  of  the  workers,  their  hours  and 
earnings  and  especially  their  change  of  address.  The  plan  of 
having  each  foreman  responsible  for  sending  change  of  ad- 
dress to  the  office  on  the  second  ^  working  day  of  each  month 
seems  to  be  the  best  way  of  keeping  track  of  the,  too  often, 
frequent  moves  of  the  workers.  If  the  person  making  a  report 
of  the  illness  of  a  worker  can  be  made  responsible  for  getting 
the  correct  address  at  that  time,  many  fruitless  errands  will 
be  avoided. 

The  records  of  the  employment  office  as  well  as  those  of  the 
first  aid  room  and  of  the  visiting  nurse  should  be  confidential. 
They  should  not  be  allowed  out  of  the  department,  should  be 
seen  only  by  those  having  business  with  them,  and  should  be 
kept  in  a  locked  case  or  in  a  locked  room.- 

1  People  are  apt  to  move  on  the  last  or  the  first  day  of  the  month. 
*  A  code  system  is  useful  for  many  entries.    See  Chapter  X. 


CHAPTER  XII 

THE   INDUSTRIAL  NURSING   CENTER 

Where  one  industry  is  responsible  for  the  growth  and 
existence  of  a  town,  the  employer  sometimes  makes  provision 
for  more  or  less  extensive  pubUc  health  and  social  work  for 
the  whole  community.  In  some  industrial  villages  this  is 
done  through  a  division  of  responsibilities,  specially  trained 
workers  being  in  charge  of  each  branch  and  the  schools, 
recreation  center,  nursing  center,  etc.,  in  separate  buildings, 
or  at  least  each  one  under  the  control  of  teacher,  social 
worker,  nurse,  etc.  In  other  industrial  villages,  schools, 
nursing,  recreation  and  other  activities  are  conducted  from 
the  same  building  with  teacher  and  nurse  as  residents, 
cooperating  in  the  management  of  recreations  and  other 
activities  with  the  help  of  workers  from  the  plant.  Where  the 
local  authorities  have  the  schools,  recreations,  care  of  public 
health,  etc.,  in  hand,  the  owner  of  the  principal  industry 
may  still  provide  a  nursing  or  health  center  of  some  sort. 
The  center  in  many  small  industrial  villages  consists  of  a 
company  hospital  from  which  nursing  and  social  work  to  a 
greater  or  less  extent,  is  carried  into  the  homes.  The  com- 
pany hospital,  however,  has  httle  use  except  in  isolated  com- 
munities where  no  general  hospitals  are  available.  Many 
employers  and  most  employes  consider  that  better  general 
and  special  care  is  obtainable  where  the  foremost  physicians 
and  surgeons  are  on  the  staff  of  a  local  hospital  rather  than 
in  one  controlled  entirely  by  an  industry. 

Where  no  industrial  hospital  is  necessary,  a  nurse's  house 
is,  in  some  towns,  used  as  headquarters  for  all  industrial 
nursing  work.  Often  living  quarters  for  the  industrial  nurse 
and  her  assistants  are  included.    With  a  house  of  this  kind, 

124 


THE  INDUSTRIAL  NURSING  CENTER       125 

many  neighborhood  activities  are  possible  and,  if  there  are 
no  local  agencies  for  public  health  education  and  social 
welfare,  almost  any  recognized  social  measures  may  be 
handled,  at  least  temporarily,  by  the  staff  of  resident  or  non- 
resident nurses.  If  one  nurse  at  least  has  social  training  and 
experience  and  has  the  social  view  point,  social  needs  may 
be  recognized  and  demonstrated  and  temporary  or  per- 
manent methods  for  meeting  them  devised. 

The  only  apparent  drawback  to  the  plan  of  a  nm-sing  center 
or  nurse's  house  where  the  nurse  lives  is  that  the  industrial 
nurse,  especially  if  she  is  without  assistants,  will  find  little 
time  for  uninterrupted  rest  or  for  relief  from  the  ever  pressing 
affairs  of  other  people.  There  must  be  some  means  of 
escape  for  the  nurse,  or  fixed  and  regular  times  when  she  is 
"not  at  home. "  This  is  hard  to  manage.  Neighbors  cannot 
imderstand  how  anj'thing  can  be  more  important  than  their 
own  affairs,  and  if  the  nurse  or  her  employer  lack  a  sense  of 
relative  values,  the  nurse  may  find  that  she  is  using  time  she 
needs  for  rest,  and  much  of  her  reserve  strength,  in  work 
which,  while  comforting  at  the  time  to  the  person  helped,  is 
often  of  Httle  real  or  lasting  value. 

If  the  staff  is  large  and  the  employer  willing,  work  may  be 
so  planned  that  it  is  possible  for  a  nurse  to  sit  up  all  night  with 
someone  beyond  help  or  to  assist  a  family  physician  with 
minor  operations  on  Sunday  or  to  attend  an  obstetrical  case 
at  whatever  time  she  is  needed.  But  the  staff  is  seldom  large 
enough  for  these  demands  and  if  the  nurse  allows  her  time  and 
strength  to  be  unduly  taxed,  her  work  in  the  plant  and  that 
which  her  employer  expects  of  her  in  the  homes,  in  addition 
to  her  own  health,  are  sure  to  suffer. 

Employers  are  reasonable  when  they  understand.  They  do 
not  want  a  worn-out  or  half-sick  nurse.  By  supporting  the 
nurse  in  resisting  temptations  or  demands  to  do  more  than 
she  can  do  well  and  by  having  the  foresight  to  uphold  her  in  a 
resolution  to  begin  with  these  calls  as  they  must  ultimately 
be  handled,  they  will  help  the  nurse  to  preserve  her  usefulness 
and  increase  the  eflSciency  of  her  work. 


126  INDUSTRIAL  NURSING 

The  industrial  nursing  center  having  been  established,  its 
growth  is  inevitable  unless  purposely  limited. 

There  will  probably  be  need  for  a  first  aid  room,  al- 
though it  may  be  possible  to  have  all  such  work  done  at  the 
plant.  The  records  of  all  the  nursing  work  may  sometimes 
conveniently  be  kept  at  the  nurse's  house.  The  nurse  will 
find  it  advantageous  or  even  necessary  to  set  aside  an  hour 
in  the  evening  for  workers  to  come  to  her  either  for  redress- 
ings  or  on  their  personal  errands. 

The  needs  of  the  visiting  nursing  service  may  call  for  the 
provision  of  a  loan  closet  containing  articles  not  found  in  the 
ordinary  home,  but  needM  when  sickness  comes.  A  cir- 
culating library  will  bring  pleasure  to  many  patients.  In  a 
small  village  such  a  library  might  be  made  to  grow  into  a  real 
public  hbrary. 

The  nurse  on  her  rounds  will  find  babies  whose  mothers  do 
not  know  how  to  give  them  proper  care.  The  efficient  super- 
vision of  a  large  number  of  babies  means,  in  addition  to  calls 
at  the  homes,  individual  talks  with  the  mothers,  home  demon- 
strations in  the  preparation  of  food  and  in  the  care  of  the 
child,  some  central  place  to  which  the  mothers  may  bring 
their  babies  at  stated  times  for  weighing,  inspection  and 
advice.  Much  follow-up  work  of  a  babies'  conference  of  this 
kind  is  possible,  with  relatively  little  extra  effort,  by  the 
industrial  visiting  nurse  on  her  regular  rounds.  If  she  lists 
the  homes  where  there  are  babies  according  to  streets,  it  is  an 
easy  matter  to  see  all  the  babies  in  a  given  district  when  other 
visits  must  be  made  on  the  same  streets.  Emergencies  and 
special  feeding  instruction  will,  however,  take  more  time. 

A  baby  conference  in  connection  with  industrial  nursing 
must  differ  in  some  respects  from  one  managed  by  a  charita- 
ble organization  or  by  the  board  of  health  in  a  large  city. 
Except  in  a  very  small,  purely  industrial  village,  baby  wel- 
fare work,  supported  by  the  employer  and  not  by  local  or- 
ganizations, cannot  in  any  sense  take  the  place  of  an  agency 
widely  supported  by  all  classes  throughout  the  community. 

In  a  baby  clinic  in  a  large  city,  a  doctor  is  in  attendance  at 


THE  INDUSTRIAL  NURSING  CENTER      127 

stated  times  even  though  he  may  refer  babies  needing  medical 
care  to  family  doctors.  In  an  informal  baby  conference  (bet- 
ter called  "Babies'  Day  or  Babies'  Afternoon")  connected 
with  an  industrial  nursing  center  it  is  usually  impractical,  if 
not  impossible,  for  local  reasons,  to  have  any  one  doctor  in 
attendance.  Some  physicians  in  industry  might  have  the 
time  to  give  and  the  interest  in  babies  which  would  make 
such  a  service  a  pleasure  to  them.  However,  the  industrial 
nurse  in  most  small  villages  must  depend  largely  on  her  own 
ability  to  enUst  the  cooperation  and  support  of  the  family 
doctor  of  each  mother. 

A  plan,  which  has  been  tried  with  some  success  and  with 
satisfaction  to  the  local  doctors  who  have  happened  to  need 
the  special  help  that  a  visiting  nurse  alone  can  give  in  the  care 
of  difficult  feeding  cases,  will  be  described  as  suggesting  a 
possible  solution  of  the  problem  of  the  care  of  well  babies  in  a 
small  industrial  village.  Sick  babies,  necessarily  having  a 
physician  in  attendance  if  visiting  nurse  care  is  to  be  given, 
offer  no  additional  problems  in  medical  and  nursing  coopera- 
tion. 

The  industrial  visiting  nurse  will  find  many  young  babies, 
children  of  workers,  in  her  daily  rounds;  children  whose 
mothers  naturally  remain  at  home  after  marriage  and  those 
whose  mothers  work  as  long  as  possible  during  pregnancy  and 
who  expect  to  work  again  outside  the  home  as  soon  as  they 
can  do  so  after  the  birth  of  the  baby.  Consideration  for  the 
welfare  of  the  next  generation  will  urge  an  employer,  in  a 
town  supporting  no  child  welfare  agencies,  to  allow  the 
visiting  industrial  nurses  time  and  opportunity  for  some,  at 
least,  of  the  so  badly  needed  instruction  of  these  mothers  and 
for  as  much  supervision  of  the  babies  before  school  age  as  is 
compatible  with  industrial  nursing  immediately  and  tangibly 
connected  with  the  present  welfare  of  the  industry  and  the 
health  of  the  present  force  of  workers. 

When  the  nurse  has  been  given  this  privilege  by  her  em- 
ployer and  can  observe  the  improvement  in  the  health, 
strength  and  happiness  of  the  babies  under  her  care,  she 


128  INDUSTRIAL  NURSING 

enters  upon  the  most  fascinating,  absorbing  and  satisfying 
branch  of  industrial  nursing. 

At  first  the  babies  will  be  found  in  the  nurse's  rounds,  but 
later  the  mothers  will,  in  many  cases,  hail  the  nurse  as  she 
passes  in  the  street  or  even  bring  their  babies  to  the  nurse's 
house.  As  the  nurse's  work  becomes  known,  the  opportu- 
nities for  getting  well  babies  under  observation  will  increase. 
The  local  doctors  will  often  refer  mothers  whom  they  have 
delivered  to  the  nurses.  Consultation  of  town  or  county 
records  will,  in  the  registration  areas,  give  the  births,  and  the 
nurse  can  make  a  call.  No  mother,  however  well  she  may 
understand  the  care  of  her  baby,  will  resent  one  such  call. 
Subsequent  visits  from  the  nurse  and  attendance  at  the 
baby  conference  will  depend  entirely  on  the  wishes  of  the 
mother.  Where  registration  of  births  is  not  complete,  local 
newspapers  will  help  in  finding  the  babies.  The  interest  of 
friends  and  neighbors  will  bring  many  cases  to  the  nurse's 
attention,  but  the  best  advertisement  will  be  the  nurse's 
popularity,  the  word  of  mouth  of  mothers  who  are  being 
taught,  and  the  support  of  the  local  physicians  who  are  known 
to  be  interested  in  child  welfare. 

The  mother  once  found  is  invited  to  bring  her  baby  to  the 
nurse's  house  on  the  Babies'  Afternoon.  If  she  comes,  the 
nurse  will  weigh  and  measure  the  baby  and  give  enough 
general  instruction  to  the  mother  to  interest  her,  and  invite 
her  to  join  the  Mothers'  Class.  A  record  will  be  made  of  the 
name  of  the  mother's  physician  or  of  the  physician  who  has 
dehvered  her  and  a  card  sent  to  him.    This  card  should  state 

that  Mrs ,  dehvered  by  him  of  a  child  (male  or 

female)  on ,  19.  .  desires  to  join  the  Mothers'  Class 

at  the  nurse's  house.  The  card  should  further  state  that 
mothers  attending  the  class  are  taught  the  care  and  feeding 
of  breast-fed  infants  and  of  normal  children,  that  deviation 
from  steady  growth  or  any  apparent  abnormality  will  be 
reported  to  him  at  once,  that  no  mother  whose  child  does  not 
seem  to  progress  in  a  satisfactory  way  will  be  allowed  to 
continue  as  a  member  of  the  Mothers'  Class  unless  a  phy- 


THE  INDUSTRIAL  NURSING  CENTER       129 

sician  is  consulted  and  will  direct  the  subsequent  medical 
care  of  the  child.  The  card  should  invite  suggestions  as  to 
improvements  in  the  work,  and  state  that  visits  to  the  class 
by  the  doctor  will  be  welcome  at  any  time. 

On  instituting  such  a  baby  welfare  service,  a  note  sent  to 
each  local  physician,  explaining  the  motives  and  asking  sup- 
port and  cooperation,  is  a  courtesy  which  should  be  appre- 
ciated by  the  medical  profession.  If  such  a  note  is  sent  out 
by  the  employer,  his  backing  and  interest  are  made  plain. 

In  teaching  the  mothers,  stress  should  be  laid  on  the  simple 
everyday  care  of  well  children,  the  advantages  of  breast 
feeding  and  when  and  how  to  give  additional  food,  the  need 
of  cleanliness  and  how  to  attain  it,  the  necessity  of  fresh  air 
and  exercise,  proper  clothing  and  suitable  play  and  the  right 
of  every  child  to  the  care  of  its  own  mother  in  a  real  home. 
Ignorance  and  desire  for  additional  money,  not  need  or  lack 
of  mother's  love,  are  in  many  cases,  the  causes  of  the  presence 
in  industry  of  women  who  would,  if  they  but  knew  it,  be  of 
much  more  value  to  family  and  nation  if  they  refrained  from 
gainful  occupation  outside  the  home  until  the  youngest  child 
reaches  an  age  when  a  mother's  care  and  a  home  is  no  longer  a 
necessity  to  his  well-being.  A  nurse  can  often  prove  this 
fact  to  individual  mothers  through  her  care  of  their  babies, 
and  it  is  not  at  all  unusual  for  a  woman  to  say  that  she  has 
decided  not  to  go  back  to  work  after  the  birth  of  her  child 
because  she  is  sure  her  baby  will  not  have  the  care  she  has 
learned  to  give  it. 

One  of  the  greatest  pleasures  the  writer  ever  experienced 
was  the  sight,  one  autumn  day,  of  a  street  in  a  poor  quarter  of 
town.  The  preceding  summer  it  had  been  difficult  to  get 
the  mothers  to  think  they  had  time  to  take  their  babies  out  of 
doors,  and  often  the  babies  had  been  placed  out  for  them.  It 
happened  that  eveiy  mother  on  the  little  street  attended  the 
Mothers'  Class  and  that  nearly  every  house  boasted  a  young 
baby.  On  the  particular  day  in  question,  ten  small  babies 
within  sight  were  out  of  doors  in  boxes,  gocarts,  pens  and  on 
the  floors  of  porches.    Supper  was  delayed  for  some  time,  a 


130  INDUSTRIAL  NURSING 

caU  was  made  on  each  mother,  and  neighborhood  gossip 
disclosed  that  the  mothers  felt  it  did  pay  to  do  all  these  things 
for  the  babies,  for  in  spite  of  a  hot  summer,  not  a  baby  on 
that  street  had  been  sick. 

When  a  baby  does  become  sick,  a  nurse  can  do  much  to 
secure  and  keep  proper  medical  supervision  by  encouraging 
the  habit  of  employing  a  family  doctor  and  discouraging  the 
unfortunate  drifting  from  one  physician  to  another  which 
some  persons  consider  necessary  when  a  sick  member  of  the 
family  is  not  immediately  relieved  by  the  first  doctor  called, 
and  which  physicians  find  so  discouraging  in  their  efforts 
for  the  relief,  cure  and  education  of  their  patients. 

This  plan  for  the  supervision  of  well  babies  is  not  by  any 
means  perfect,  but  it  has  been  described  because  the  writer 
has  not  been  able  to  discover  any  better.  Where  it  was  last 
known  to  have  been  tried,  it  was  meeting  with  very  real 
success  in  keeping  well  babies  well.  While,  in  the  beginning, 
the  work  of  the  industrial  nurses  was  observed  by  the  local 
physicians  with  great  indifference,  during  the  latter  part  of 
the  first  summer  and  to  a  greater  extent  during  the  second 
summer,  both  well  and  sick  babies  in  such  large  numbers 
were  referred  by  the  local  physicians  to  the  industrial  nurses 
that  it  was  only  with  great  difficulty  they  were  able  to  re- 
spond to  all  the  requests  for  help.  At  the  end  of  the  second 
summer  most  of  the  physicians  were  ready  to  try  as  a  general 
community  agency,  the  plan  of  a  community  baby  confer- 
ence to  extend  the  work  already  being  done  by  the  industrial 
nurses.  This  was  specially  gratifying,  as  a  milk  station  had 
been  in  existence  for  one  summer  before  industrial  nursing 
had  been  established  and  was  abandoned  because  the  local 
physicians  considered  it  not  suitable  to  their  needs  or  to  the 
needs  of  the  community. 

Prenatal  Supervision  by  Industrial  Nurses:  The  proper  care 
of  mothers  during  pregnancy  and  labor,  is  now  recognized 
everywhere  to  be  the  logical  beginning  of  baby  welfare  work, 
and  the  industrial  nurse,  through  her  knowledge  of  industry, 
as  well  as  of  home  conditions,  cannot  afford  to  ignore  her 


THE  INDUSTRIAL  NURSING  CENTER       131 

special  opportunities  to  advance  the  cause  wherever  her 
work  Hes.  A  large  community  often  offers  opportunities 
for  cooperation  in  this  field  with  existing  agencies,  but,  in 
the  small  industrial  village,  such  agencies  seldom  exist  and 
the  nurse  may  be  obliged  to  make  the  first  step  herself.  The 
support  of  her  employer  may  depend  on  the  presentation 
of  a  workable  plan  wliich  will  not  demand  much  additional 
time,  funds  or  space.  Fortunately  such  a  plan  is  perfectly 
practical  and  may  be  carried  out  with  little  additional  effort 
by  industrial  visiting  nurses  who  already  know  the  town  and 
the  workers  and  who  have  a  better  chance  than  other  visiting 
nurses  for  finding,  in  the  early  months,  a  large  proportion  of 
pregnant  women  in  the  industrial  group. 

Women  employes,  who  become  pregnant,  are  usually 
forced  to  remain  at  home  for  a  time  in  the  early  weeks  even 
though  they  return  to  work  later.  Where  a  system  of  prompt 
visiting  is  carried  out  the  visiting  nurse  is  sure  to  see  these 
women.  The  nurse  in  the  plant  frequently  discovers  preg- 
nant women.  Others  are  found  as  she  goes  into  the 
homes  on  other  errands.  As  the  interest  of  the  nurse 
becomes  known,  women  come  to  her,  and  husbands  who 
are  employes  will  sometimes  ask  the  nurse  to  see  their 
wives  even  though  the  wives  do  not  work.  Few  women 
of  the  working  classes  consider  medical  care  necessary  until 
labor  begins,  but  the  visits  of  the  nurse  are  always  welcomed. 
Much  may  be  done,  in  a  very  informal  way,  by  simply  ad- 
vising any  expectant  mother  seen.  All  interested  visiting 
nurses  do  much  of  this  sort  of  casual  teaching  as  they  go 
about  and,  as  it  is  so  casual,  httle  note  and  probably  no 
record  is  made  of  it.  Valuable  as  this  passing  attention  is, 
a  much  wider  and  more  lasting  good  may  be  accomplished 
by  a  httle  effort  for  thoroughness. 

Needless  to  say  the  first  duty  of  the  nurse  who  is  consulted 
by  a  pregnant  woman  is  to  discover  whether  she  has  seen  her 
physician  and  if  she  has  not,  to  persuade  her  to  do  so  at  once. 
Patients  often  hesitate,  fearing  the  expense.  Cooperation 
with  the  local  physicians  helped  to  solve  the  question  for  one 


132  INDUSTRIAL  NURSING 

industrial  nurse.  The  objection  of  the  women  was  stated 
to  them  and  they  all  agreed  gladly,  at  the  suggestion  of  one 
of  their  number,  to  rebate,  at  the  time  of  dehvery,  all  charges 
for  office  visits  made  by  the  women  solely  for  medical  ob- 
servation of  normal  pregnancy.  Early  consultation  enabled 
them  to  plan  their  time  more  economically,  to  say  nothing 
of  greater  ease  to  both  doctor  and  patient  at  the  time  of  de- 
livery. 

A  nurse  is  often  welcomed  by  the  doctor,  after  he  has  ex- 
amined the  patient,  for  her  abihty  to  observe  untoward 
symptoms,  make  routine  urine  examinations  and  give  gen- 
eral instruction  to  the  woman  in  the  care  she  should  take  of 
herself  and  the  preparations  she  should  make  for  her  confine- 
ment and  for  her  coming  child. 

An  afternoon  at  the  nurse's  house  set  aside  for  these 
women,  when  many  are  being  supervised,  will  lighten  the 
labors  of  a  nurse  already  well  occupied.  Many  of  them  will 
gladly  call  on  the  nurse  if  they  are  sure  they  will  only  meet 
other  women  in  the  same  condition.  The  routine  urine  ex- 
aminations may  then  be  made  and  the  necessary  instruction 
given  in  groups  or  singly.  In  one  visiting  nurse  center, 
where  prenatal  care  is  given,  the  women  are  taught  to  make 
baby  clothes  and  to  prepare  all  pads,  etc.,  for  the  dehvery. 
The  women  furnish  their  own  material  but  are  taught  to 
use  old  linen  for  pads,  to  make  over  clothes  for  the  baby  and 
any  other  economical  measures  that  appear  practical. 

One  of  the  greatest  services  a  sympathetic  nurse  can  render 
a  young  and  probably  frightened  expectant  mother  is  to  give 
her  an  imderstanding  of  what  is  to  come  and  inspire  her  with 
confidence  that  she  will  endure  the  trial  well  and  quickly 
forget  it. 

If  confidence  in  the  nurse  is  well  estabhshed  during  the 
expectant  period,  the  subsequent  supervision  of  the  child 
with  assured  breast  feeding  and  care  by  its  own  mother  is 
much  more  likely  to  be  accomplished. 

Visits  to  the  nursing  center  both  by  pregnant  women  and 
by  those  with  children  are  of  additional  benefit  by  getting 


THE  INDUSTRIAL  NURSING  CENTER       133 

mothers  and  babies  out,  and  discouraging  the  close  housing 
of  the  httle  ones  in  the  winter  time.  A  little  air  of  festivity 
on  afternoons  given  up  to  this  work  will  make  for  their  seem- 
ing importance  in  the  eyes  of  the  mothers.  A  hot  drink  in 
winter  and  a  cool  one  in  summer  will  also  prove  an  attrac- 
tion and,  after  a  busy  morning  followed  by  the  walk  to  the 
nurse's  house,  may  even  be  needed  by  both  pregnant  and 
nursing  women.  Where  there  is  no  fund  for  purchasing  re- 
freshments and  possibly  in  any  case,  a  small  sum  from  each 
woman  (perhaps  in  the  form  of  weekly  or  monthly  dues) 
would  provide  the  necessary  food  and  also  give  the  mothers  a 
sense  of  responsibihty  in  the  upkeep  of  their  class.  Weekly 
committees  might  be  formed  among  the  women,  each  pro- 
viding the  refreshment*for  one  afternoon. 

The  Industrial  Day  Nursery: — A  so-called  welfare  agency 
carried  on  by  some  employers  before  the  Great  War  and  by 
more  since  deserves  mention.  Day  nurseries,  whether  pro- 
vided by  employers  of  labor  or  under  local  charitable  or 
commercial  management,  offer,  at  best,  a  poor  solution  to  the 
problems  of  mothers  of  families  without  a  breadwinner. 
With  the  growing  realization  of  the  child's  value  to  the  state 
and  the  advantages  of  a  normal  home  in  his  physical,  mental 
and  spiritual  development,  together  with  the  extension  of 
state-supported  mother's  pension  systems,  we  may  see  the 
time  when  a  day  nursery,  even  for  fatherless  children,  will 
be  as  much  a  thing  of  the  past  as  the  old  time  poor  farm  care 
of  orphans  in  a  progressive  and  enhghtened  community. 
When  the  natural  breadwinner  of  a  family  is  hving  and 
healthy,  something  is  wrong  in  a  social  system  that  drives  or 
coaxes  the  mother  of  his  young  children  into  gainful  occupa- 
tion outside  her  home.  The  trend  of  legislation  shows  that 
public  opinion  is  being  roused  to  the  fact  that  a  young  child 
has  a  right  to  the  care  of  his  mother  in  a  real  home,  even 
though  the  state,  by  pensioning  the  mother,  must  take  upon 
itself  the  responsibility  of  the  deceased  breadwinner. 

Some  socially  minded  employers  of  labor  realize  that  they 
would  only  defeat  their  purpose  by  giving  women  work  to 


134  INDUSTRIAL  NURSING 

the  detriment  of  their  families.  Certain  others  argue  that, 
if  the  children  have  good  care  and  suitable  food  in  a  day 
nursery  at  the  plant,  no  harm  can  come  from  the  employ- 
ment of  their  mothers. 

UntU  pubhc  opinion  fully  recognizes  the  mutual  need  of 
mother  and  child  for  each  other  and  the  disastrous  results 
to  individuals  and  to  the  race  of  separating  them,  industrial 
nurses  will  sometimes  be  asked  to  aid  in  the  management  of 
industrial  day  nurseries.^ 

iDAY  NURSERIES  IN  FACTORIES 

The  War  Labor  Policies  Board  has  adopted  a  resolution  setting  forth 
the  Government's  attitude  toward  the  employment  of  women  in  war 
industries.  The  principles  embodied  in  this  resolution  have  been  ap- 
proved by  all  the  production  and  distribution  agencies  of  the  Govern- 
ment.   Paragraph  3,  Section  3,  of  the  resolution  reads  as  follows: 

"The  recruiting  of  mothers  of  young  children  for  war  industries  should 
be  discouraged." 

"The  object  of  establishing  day  nurseries  in  factories  is  obviously  to 
increase  and  facilitate  the  employment  of  mothers  of  young  children. 
The  National  Consumers'  League  has  always  protested  against  the 
establishment  of  such  day  nurseries,  as  one  item  in  its  campaign  against 
the  employment  of  mothers  of  young  children. 

" The  objections  to  such  employment  are  manifold.  Some  of  the  most 
important  being: — 

"(a)  A  young  chUd  normally  belongs  with  its  mother  in  its  home. 
Whatever  tends  to  transplant  either  or  both  to  the  factory, 
tends  to  dismember  the  home  to  the  injury  of  both  mother  and 
chnd. 
"  (6)  In  peace  time  the  one  valid  reason  for  the  creation  of  day 
nurseries  is  that  many  working  class  mothers  are  temporarily 
disabled  by  suspected  tuberculosis,  or  insanity,  or  are  in  the 
hospital  for  confinement  or  for  surgical  care,  and  the  father  can- 
not keep  the  household  together  unless  there  is  a  day  nursery  to 
tide  over  the  crisis  until  the  mother's  return.  There  is  no  sug- 
gestion that  day  nurseries  in  factories  have  any  such  basis. 
"  (c)  Institutional  care  of  children  is,  under  all  circumstances,  to  be 
avoided,  if  any  better  way  can  be  found ;  and  mothers'  pensions, 
funds-to-parents  acts,  the  Red  Cross  Home  Service,  and  nu- 
merous scholarship  funds  for  school  children  in  the  elementary 
grades  exemplify  better  ways  of  providing  for  the  children  than 
the  best  day  nursery  even  outside  of  a  factory. 
"  (d)  If  the  excuse  for  having  a  day  nursery  in  a  factory  is  that 
mothers  of  young  children  are  indispensable  to  present  war 
production,  the  burden  of  proof  is  on  all  who  make  this  unproven 
assertion. 
"So  long  as  there  are  any  cherished  daughters  of  suitable  a^ 


THE  INDUSTRIAL  NURSING  CENTER       135 

If  the  employer  finds  no  other  immediate  solution  of  his 
own  difficulties  and  those  of  the  working  mother,  and  the 
employment  of  mothers  of  little  children  is  a  fact,  then, 
unquestionably,  it  is  the  duty  of  the  industrial  nurse  to  make 
sure  by  every  means  permitted  her  that  the  children  and  their 
mothers  have  all  that  is  possible  in  the  way  of  care,  comfort 
and  consideration.  An  investigation  into  the  disposal  of  the 
children  while  their  mothers  are  at  work  should  be  made. 
With  no  day  nursery  accessible,  the  babies  are  rarely  left 
where  they  will  have  as  good  care  as  their  mothers  would 
give  them  and  almost  never  are  they  treated  with  as  much 
love  and  patience.  No  matter  how  poor  a  mother  a  woman 
may  be,  she  nearly  always  leaves  her  baby  with  another 
woman  a  httle  dirtier,  a  little  more  impatient,  and  with  less 
affection  for  the  child. 

If  we  admit  that  the  baby  must  suffer  by  the  separation, 
what  about  the  mother  who  must  rise  early,  prepare  break- 
fast, wake,  dress  and  feed  her  babies,  perhaps  wash  or  iron, 
do  a  Httle  casual  housework,  take  the  children  to  the  neighbor 
or  to  the  nursery  and  be  at  her  own  work  at  seven  o'clock? 
At  noon  she  may  rush  home  to  nurse  the  baby  or  she  may  be 
obliged  to  suffer  until  night  because  she  cannot  do  so.  She 
can  hardly  avoid  losing  her  milk.  If  she  is  a  normal  woman, 
she  cannot  escape  constant  anxiety  about  her  child.  At 
night  she  reverses  the  work  of  the  morning.  She  goes  for 
the  children,  takes  them  home,  prepares  supper  or  brings 
in  an  unwholesome  something  from  the  store,  puts  the  babies 

for  it  in  comfortable  homes,  every  exertion  should  be  made  to 
get  them  to  do  factory  work,  before  any  mother  should  be  asked 
to  take  her  little  child  to  the  factory.     Masses  of  colored  men 
and  women,  eager  to  get  into  industry  and  now  discouraged  from 
doing  so,  should  be  employed  in  preference  to  mothers  of  young 
children. 
"Until  these  sources  of  labor  power  are  utterly  exhausted,  the  Con- 
sumers' League  will  continue  its  earnest  protest  both  against  mothers  of 
young  children  going  to  the  factory  themselves,  and  against  their  taking 
their  little  ones  with  them.    Such  day  nurseries  are  a  hideous  perversion 
of  philanthropy,  a  travesty  of  charity."    Florence  Kelley. 
September  25,  1918. 
From  The  Churchman. 


136  INDUSTRIAL  NURSING 

to  bed,  sews,  washes,  irons,  cleans  until  she  is  forced  to  drop 
into  bed.  Perhaps  her  rest  is  broken  by  a  nursing  baby,  older 
children  may  disturb  her  and  she  will  probably  be  too  tired 
to  sleep  well.  She  gets  farther  behind  with  her  work  each 
day,  takes  less  care  in  preparing  food,  finds  herself  unable 
to  do  all  that  she  wants  to  do,  grows  discouraged  with  the 
endless  grind  and  finally  becomes  sick.  The  writer  has  for 
years  watched  many  young  mothers  in  industry  and  a  recent 
review  of  their  names  shows  few  who  were  able  to  keep  up 
the  pace.  Where  the  husband  did  not  or  could  not  support 
his  wife  at  home,  the  almost  certain  outcome  was  that  the 
children,  or  mother  and  children,  became  charges  on  pubhc 
or  private  charity.  Had  they  been  helped  to  lead  normal 
fives,  this  might  have  been  avoided.  As  it  is,  tuberculosis, 
nervous  breakdown  and  other  misfortunes  have  claimed 
many  mothers,  and  their  children  who  have  survived  are 
growing  up  in  institutions  or  are  struggling  for  self-support 
without  mental  or  physical  preparation.  Proper  care  for 
mothers  and  children  without  breadwinners  should  be  pro- 
vided by  the  state.  Mothers'  pensions  should  be  provided 
for  and  accepted  by  those  needing  them  in  the  same  spirit 
that  the  pubfic  schools  are  provided  by  the  state  and  ac- 
cepted by  aU  classes. 

Where  mothers  of  young  children  are  employed,  the  super- 
vision of  the  care  of  the  children  may  be  accompfished  in  two 
ways: — by  the  day  nursery  and  by  carefully  selected  and 
supervised  boarding  places  in  the  neighborhood  of  their 
homes.  The  industrial  nurse  who  visits  in  the  homes  should 
make  it  her  business,  if  her  employer  will  permit,  to  visit 
the  children  of  mothers  who  are  employes  and  work  out  a 
plan  for  systematic  oversight.  The  mothers  will  be  appreci- 
ative and  many  caretakers  will  take  pride  in  their  work 
when  they  are  aware  it  will  be  noticed  and  that  the  mother 
will  be  informed  when  her  child  has  good  care,  as  well  as 
when  it  is  neglected.  In  a  small  plant  in  a  small  town,  the 
few  babies  requiring  supervision  may  be  seen  while  making 
the  regular  daily  calls.    In  a  large  city  much  time  and  effort 


THE  INDUSTRIAL  NURSING  CENTER       137 

must  be  expended  in  searching  out  all  the  babies  left  with 
others  by  their  working  mothers.  Careful  cooperation  with 
the  employment  office  and  interviews  with  all  new  women 
employes,  and  with  any  returning  after  an  absence,  should 
discover  those  with  young  children.  Cooperation  with 
nursing  and  child  welfare  agencies  will  do  much. 

But  the  whole  thing  is  wrong,  and  the  industrial  nurse 
who  is  alive  to  her  responsibilities  and  to  her  privileges  will 
spare  no  pains  to  enlist  the  sympathy  and  understanding 
of  her  employer  and  aid  in  the  forming  of  a  consistent  poHcy 
which  will  result  in  the  exclusion  of  the  mothers  of  little 
children  from  industry.  Here  the  records  may  help  to  point 
the  argument.  If  a  special  file  is  ^  kept  for  the  disabilities 
and  work  records  of  employes  who  are  mothers  of  young 
children,  it  cannot  fail  to  yield  valuable  facts  as  to  the  in- 
juries sustained,  illnesses  suffered,  time  lost  from  other  causes 
and  the  amount  of  their  output  as  compared  with  women 
having  less  heavy  responsibilities. 

Persons  drawing  up  bills  for  proposed  health  insurance 
laws  should  have  this  subject  in  mind  together  with  that  of 
maternity  benefits  for  working  mothers.^ 

If,  for  the  present,  there  must  be  industrial  day  nurseries, 
the  industrial  nurses  should  be  ready  to  help  make  them 
places  which  will,  as  far  as  possible,  provide  the  children 
with  all  they  need  during  the  day: — light  and  air,  suitable 
food  and  clothing,  protection  from  the  danger  of  infection, 
means  for  wholesome  play  and  instruction,  and  the  under- 
standing care  of  attendants  who  truly  love  children. 

In  some  cities  the  construction,  equipment  and  manage- 
ment of  day  nurseries  is  controlled  by  law.  If  the  employer 
provides  a  day  nursery,  it  should  have  the  careful  supervision 
of  the  industrial  nurse.  All  children  should  have  a  physical 
examination  by  the  doctor  before  admission.  They  should 
be  inspected  daily  by  a  nurse  to  see  that  they  are  clean,  well 
fed  and  happy,  as  well  as  for  the  prevention  of  contagion. 

1  See  Chapter  X,  Records. 

^  See  footnote,  Chapter  I,  page  6. 


138  INDUSTRIAL  NURSING 

They  should  have  periodical  reexaminations  by  the  doctor 
and  should  receive  whatever  medical  or  surgical  care  is 
indicated.  No  child  under  six  months  or  over  fourteen 
years  should  be  admitted  without  special  recommendation 
and  investigation. 

There  must  be  separate  toilets  for  boys  and  girls  old  enough 
to  run  about.  Plenty  of  space  (at  least  300  cubic  feet  for 
each  person)  ^  must  be  provided.  Window  space  at  least  one- 
eighth  of  the  floor  space  is  necessary  for  light  and  air,  and  the 
windows  should  not  open  on  courts  or  narrow  streets.  No 
basement  rooms  should  be  used.  There  should  be  an  isolation 
room,  a  room  with  cots  for  naps,  and  space  for  play,  indoors 
and  out. 

No  common  toilet  articles  must  be  allowed.  Each  child 
should  have  towel,  wash  cloth,  tooth  brush  and  cup  and  they 
should  be  numbered  to  correspond  with  the  hooks  on  which 
they  hang.  Each  child  should  be  identified  with  the  num- 
ber used  for  his  own  articles.  Dining  tables  should  be 
attractive  and  the  utensils  should  be  handled  in  a  sanitary 
manner. 

Proper  diets  must  be  planned  for  all  ages,  and  special  care 
must  be  given  to  the  preparation  of  artificial  or  supplementary 
feedings  for  infants  of  nursing  age.  The  cooperation  of  the 
company  physician  or  of  some  baby  specialist  is  essential 
in  the  feeding  of  the  babies,  the  prevention  of  malnutrition 
and  the  treatment  of  undernourished  children. 

Provision  should  be  made  for  supervised  play  and  for  in- 
struction suited  to  the  age  of  the  children.  Those  of  school 
age  will  probably  be  in  the  public  school  during  school  hours. 
Older  children  may  get  something  of  the  feeling  of  a  normal 
home  by  being  given  some  instruction  in  the  care  of  the  Httle 
ones,  and  a  measure  of  responsibility  for  their  welfare. 

Any  one  who  establishes  a  day  nursery  has  responsibilities 

other  than  the  physical  care  of  children.    Since  it  has  been 

proved  that  dependent  children  do  far  better  in  the  homes 

of  women  who,  even  if  poor,  give  them  affection  and  a  normal 

'  Minimum  legal  requirement  in  Cleveland. 


THE  INDUSTRIAL  NURSING  CENTER       139 

home  atmosphere,  than  in  institutions  however  elaborate, 
no  one  with  any  understanding  of  the  needs  of  childhood  will 
be  satisfied  with  a  social  or  industrial  program  which  makes 
it  possible  to  separate  any  little  child  from  a  healthy,  affec- 
tionate, normal  mother  while  she  is  forced  or  enticed  into 
work  outside  her  home. 

Little  Mothers'  Clubs: — The  many  young  girls  in  industrial 
villages  who  must  have  more  or  less  of  the  care  of  younger 
brothers  and  sisters  will  gain  much  in  capability  and  self- 
respect  if  they  can  be  given  some  training  in  the  care  of 
children  at  the  industrial  nursing  center.  A  little  mothers' 
class,  organized  on  the  lines  of  those  already  in  existence,^ 
will  be  the  means  of  teaching  these  young  people  not  only 
to  give  better  care  to  the  younger  members  of  their  families, 
but  will  also  teach  them  to  be  more  intelligent  mothers  when 
they  have  babies  of  their  own.  A  group  of  young  girls  or- 
ganized into  a  club  might  be  of  great  help  to  the  commu- 
nity by  watching  out  for  the  welfare  of  all  babies  and  bringing 
to  the  nurse's  attention  those  who  need  her  care. 

Further  development  is  possible  along  similar  lines,  as  home 
nursing  classes.  Red  Cross  courses,  and  lessons  in  cook- 
ing and  sewing.  The  nurse  may  find  fellow  workers  in  the 
plant  who  are  able  and  wilhng  to  teach  others.  For  instance, 
in  one  department  store,  the  milhners  teach  millinery  in  the 
women's  club  classes.  Men  may  be  found  who  are  natural 
leaders  and  who  will  gladly  organize  the  boys  and  men  for 
recreation  and  study.  Although  not  so  common,  such  leaders 
may  also  be  discovered  among  the  women  and  girls. 

Recreational,  educational  and  general  welfare  activities, 
in  order  to  hold  the  interest  of  the  people,  should  originate 
in  the  needs  and  conscious  desires  of  those  to  be  served.  If 
the  people  are  drawn  into  the  actual  work,  led  to  think  and 
plan  for  their  own  welfare,  they  will  profit  by  the  use  of  the 
nursing  center  as  a  community  center.  To  this  end  the 
natural  leaders  of  the  people  must  be  discovered.    An  up-to- 

1  In  New  York  City  such  clubs  are  managed  in  connection  with  the 
school  nursing. 


140  INDUSTRIAL  NURSING 

date  periodical,  edited  and  published  by  the  employes,  Is  a 
great  help  in  stimulating  interest  and  in  forming  opinion. 

Cooperation  between  employers  and  employes  is  thought 
by  many  to  hold  the  solution  of  most  of  our  industrial  prob- 
lems. In  no  field  can  this  cooperation  be  made  of  more  value 
than  in  industrial  welfare  work.  The  plan,  followed  in  some 
organizations,  of  having  such  work  in  charge  of  committees 
chosen  by  representatives  from  all  departments  offers  op- 
portunity for  getting  the  real  opinions  of  the  workers.  The 
industrial  nurse  who  is  so  fortunate  as  to  be  identified  with 
a  firm  practicing  such  cooperation  enjoys  many  advantages 
over  one  who  is  employed  and  directed  by  one  group  of  per- 
sons while  she  is  expected  to  serve  an  entirely  different  class 
of  people. 

The  House: — If  the  industrial  nurse  has  an  opportunity  to 
assist  in  the  planning  of  the  nursing  center  she  may  be  able  to 
add  to  its  suitabihty  to  the  work  and  to  its  comfort  as  a 
dwelling. 

A  house  approaching  in  general  appearance  the  better 
houses  in  the  neighborhood  is  more  in  accord  with  the  work 
contemplated  than  a  pretentious  structure.  The  comfort  of 
the  residents  will  be  enhanced  by  Hving  quarters  separate  and 
away  from  the  parts  of  the  house  used  for  other  purposes.  A 
hving  room  and  a  dining  room,  or  a  room  to  be  used  for  both 
purposes,  a  bedroom  for  each  resident,  a  kitchen  and  bath 
and  probably  a  room  for  a  housekeeper  will  be  needed.  A 
larger  place  will  offer  no  more  comforts  and  will  add  mate- 
rially to  the  housekeeping  responsibilities. 

No  general  plan  seems  to  fit  all  the  varied  needs  of  indus- 
trial villages.  Where  the  nursing  center  is  to  be  used  as  a 
general  community  center  a  useful  nucleus  consists  of  a 
reception  room,  an  assembly  hall,  a  first  aid  room,  office,  and 
possibly  a  rest  room.  With  a  sufficient  staff  use  would  be 
found  for  a  model  apartment  for  teaching  housekeeping  and 
for  class  rooms. 

PubUc  baths,  swimming  pools,  canteens,  clubrooms,  dance 
halls,  bowling  alleys,  ball  grounds,  tennis  courts,  gardens  and 


THE  INDUSTRIAL  NURSING  CENTER       141 

other  means  for  recreation  and  advancement  are  provided 
by  some  employers.  In  a  welfare,  mdustrial  or  community 
center  of  such  extent,  a  manager  of  special  executive  ability  is 
required.  A  nurse  assuming  such  duties  would  necessarily 
have  on  her  staff  a  number  of  assistants.  There  is  no  reason 
why  a  nurse  of  executive  ability  should  find  the  management 
of  such  a  center  any  more  difficult  than  the  management  of  a 
large  hospital. 

In  the  foregoing  chapter,  the  aim  has  been  to  describe, 
with  as  much  detail  as  possible,  a  few  activities  in  connection 
with  industrial  nursing  centers  which  have  responded  to  the 
pragmatic  test  of  Mr.  Dooley,  that  "they  work,"  to  suggest 
what  employers  are  trying  out  with  the  help  of  industrial 
nurses,  and  to  indicate  what  may  be  the  logical  development, 
in  some  towns,  of  the  industrial  nursing  center  as  a  com- 
munity center  as  well  as  a  health  center. 


CHAPTER  XIII 

Food 

a  company  lunch  room  as  a  canteen  and  as  a  (lass- 
room  for  instruction  in  home  problems 

A  discussion  of  industrial  nursing  would  be  incomplete 
without  special  mention  of  the  opportunities  of  the  industrial 
nurse  in  furthering  the  provision  of  proper  food  for  the  work- 
ers and  in  educating  them  in  the  principles  of  nutrition. 

The  first  aid  nurse  and  the  visiting  nurse  will  discover  in 
the  improper  feeding  of  children,  mothers  and  workers  one 
of  the  main  causes  of  inefficiency,  unhappiness  and  ill  health. 
Where  there  is  no  canteen  service  for  the  workers  the  indus- 
trial nurse  should  soon  have  a  variety  of  recorded  facts  to 
show  the  economic  value  of  the  provision  of  well-planned 
warm  lunches  in  clean,  comfortable  surroundings. 

In  trades  where  poisons,  such  as  lead,  are  used,  it  can  be 
shown  that  workers,  eating  meals  at  their  machines,  or  in 
corridors,  do  so  without  washing,  and  poisoning  may  be 
traced  to  this  cause.  It  may  be  proved  that  piece  workers  do 
not  rest  during  the  noon  hour  if  allowed  to  eat  in  their  work 
rooms.  A  study  may  be  made  of  the  afternoon  output  of 
those  who  remain  at  their  machines  and  this  may  be  com- 
pared with  the  output  of  those  who  lunch  outside.  It  can 
sometimes  be  shown  that  ''horse-play"  in  the  plant  during 
the  noon  hour  is  responsible  for  accident  to  workers  and  for 
injury  to  machines.  Delicate  materials  are  often  injured 
when  the  workers  do  not  leave  their  places  to  wash  and  eat 
their  noonday  meal.  Immoral  conditions  have  been  made 
possible  by  allowing  workers  to  wander  at  will  through  tem- 
porarily deserted  parts  of  the  plant. 

Even  if  no  direct  injury  to  workers,  output  or  equipment 

142 


FOOD  143 

can  be  shown,  the  cost  incident  to  continual  war  on  the  in- 
evitable rats,  mice  and  cockroaches  should  be  placed  in  the 
balance.  Undoubtedly,  bits  of  food  left  carelessly  lying 
about  the  plant  after  the  workers  have  had  their  lunches  will 
attract  these  dangerous  pests. 

Most  labor  laws  provide  for  a  lunch  period  of  from  forty- 
five  to  sixty  minutes  and,  unless  the  workers  go  to  their  own 
homes  for  a  warm  meal,  and  for  change  of  air  and  relaxation,  a 
company  lunch  room  is  essential  for  their  health  and  well- 
being,  for  the  protection  of  materials,  machinery  and  plant, 
as  well  as  for  the  maintenance  of  the  maximum  output.  It 
should  be  clearly  understood  that  the  efficient  lunch  room  is 
not  a  charity.  It  is  an  essential  part  of  the  equipment  of  the 
plant.  It  helps  to  keep  the  employes  from  the  pastry  shop 
with  its  rich  starchy  foods  and  from  the  soda  fountain  at  the 
corner  drug  store.  It  is  so  closely  associated  with  the  preven- 
tion of  industrial  injuries  and  disease  that,  unless  it  is  man- 
aged by  a  trained  and  experienced  dietitian,  the  lunch  room  is 
the  legitimate  concern  of  the  industrial  nurse.  Many  nurses 
find  it  possible  to  supervise  a  lunch  room  in  addition  to  other 
duties.  In  a  large  plant,  however,  the  management  of  the 
company  canteen  by  the  industrial  nurse  would  require 
special  training  or  experience  as  a  dietitian.^ 

Physical  examination  of  the  lunch  room  employes  should 
be  required.  Even  workers  who  assist  in  serving  during  the 
busy  hours,  but  who  are  charged  to  other  departments, 
should  be  examined  by  a  physician.  This  should  be  done 
primarily  for  the  protection  from  infection  of  those  eating  in 
the  lunch  room,  but  in  addition  the  examination  might  easily 
yield  results  in  the  discovery  of  remediable  conditions,  in  the 
adjustment  of  work  to  workers  and  of  workers  to  work  which 
would  prove  the  economic  value,  both  to  the  workers  and  to 
the  employer,  of  general  physical  examinations  as  a  routine 
policy.  Proper  toilet  facilities  for  the  lunch  room  employes 
must  be  provided.  It  must  be  made  easy  for  them  to  keep 
their  hands  clean  and  someone  must  see  that  this  is  done. 
1  See  Chapter  IV,  page  20. 


144  INDUSTRIAL  NURSING 

It  seems  to  be  the  general  policy  of  employers  who  provide 
lunch  rooms  for  their  workers  to  consider  the  space,  equip- 
ment and  often  part  or  even  all  of  the  service  as  a  legitimate 
overhead  charge  for  the  plant.  Some  employers  provide  the 
lunch  also  without  cost  to  the  worker.  In  most  plants,  how- 
ever, the  workers  are  charged  a  sufficient  sum  to  cover  the 
actual  cost  of  raw  food  as  well  as  the  cost  of  preparation  and 
service. 

Employers  sometimes  give  or  sell  the  privilege  of  supplying 
the  food  to  local  caterers.  By  this  plan  both  the  employer  and 
the  employ^  are  almost  sure  to  be  exploited.  The  lunch  room 
should  not  escape  being  a  charity  to  become  a  money  making 
scheme  for  some  outsider.  Unless  the  company  considers  the 
noonday  meal  of  enough  importance  to  provide  for  at  least 
part  of  the  expense,  just  as  it  provides  chairs  and  clothes  lock- 
ers, it  will  be  necessary  in  fixing  prices  to  allow  a  larger  mar- 
gin for  accidents,  sudden  change  in  market  conditions,  etc. 

Some  employers  put  the  management  of  the  lunch  room  in 
the  hands  of  a  committee  of  workers,  a  plan  which  has  been 
loiown  to  work  to  the  satisfaction  of  everyone.  One  such 
committee  manages  the  finances  of  the  lunch  room  so  wisely 
that  the  receipts  cover  the  cost  of  food,  service  and  breakage, 
and  there  is  also  a  surplus  which  pays  for  publishing  the 
employes'  newspaper,  for  the  expense  of  the  monthly  dances 
and  often  for  other  amusements.  The  prices  are  so  low  and 
the  food  is  so  good  that  a  visitor  finds  it  hard  to  believe  that 
any  money  can  be  left  over  after  paying  for  the  food  and 
service.  The  employes  of  the  Bureau  of  Engraving  and 
Printing  in  Washington  conduct  a  lunch  room  with  space  and 
equipment  provided  by  the  bureau.  That  this  is  successful  is 
shown  by  the  fact  that  seventy  per  cent  of  the  employes 
patronize  it.  The  management  of  a  lunch  room  by  a  com- 
mittee of  employes  can  only  be  successful  if  they  see  the 
wisdom  of  expert  supervision  of  the  actual  catering. 

The  plan  of  figuring  the  overhead  charges  not  assumed  by 
the  company  such  as  management,  service,  etc.,  and  making 
this  a  fixed  charge  to  each  patron  has  been  tried.    This  fixed 


FOOD  145 

charge  is  found  by  computing  the  cost  of  management, 
service,  breakage,  etc.,  making  an  allowance  for  error, 
accident  and  depreciation.  The  sum  found  in  this  way  is  then 
divided  by  the  number  of  meals  served  during  the  same 
period.  To  the  fixed  charge  is  added  the  actual  cost  of  the 
raw  material  of  each  portion  ordered  and  the  sum  is  the  cost 
of  the  meal  to  the  worker. 


Specimen  Meal  Check  * 

Fixed  charge 

.07 

Beef  stew 

.09 

Potatoes 

.02 

Turnips 

.01 

Spinach 

.03 

Bread 

.01 

Butter 

.01 

Ice  cream 

.04 

Coffee 

.01 

Milk  for  coffee 

.01 

Total  .30 

On  the  other  hand,  there  may  be  patrons  who  bring  most  of 
their  lunch  from  home,  and  buy  only  soup  or  a  beverage.  If 
the  entire  fixed  charge  for  service  is  added  to  their  bill  they 
will  complain  and  say  that  a  disproportionate  amount  is 
being  charged  to  them.  This  plan  is  suggested.^  Obtain 
the  figm*es  for  the  total  overhead  charges  and  for  the  raw 
food  cost  for  any  given  month.  Determine  the  percentage  of 
total  expenditure  spend  for  food  and  for  overhead.  In  the 
above  check  the  expenditure  for  food  is  23c.  and  fixed  charges 
total  .07.  That  gives  a  proportion  of  approximately  3  to  1. 
Then  for  every  .03  spent  for  food  .01  should  be  added  for 
fixed  charges.  Experience  has  shown  that  bread  and  butter 
or  coffee  and  milk  are  usually  taken  together,  so  that  the 
objection  that  less  than  .01  would  have  to  be  charged  is 
not  a  serious  one.    The  menu  chart  would  then  read: — 

1  These  prices  arc  for  illustration  only.  Unsettled  market  conditions 
in  1919  forbid  any  inclusion  of  price  lists  for  guidance. 

^  Miss  Katherine  A.  Fisher,  Instructor  in  Household  Arts,  Teachers 
College,  Columbia  University,  kindly  revised  part  of  this  chapter  and 
the  suggestion  is  hers. 


146  INDUSTRIAL  NURSING 

Menu  Cost  Fixed  charge 

Beef  stew 9c 2c. 

Potatoes 2c ^c. 

Turnips Ic 3^c. 

Spinach 3c Ic. 

Bread Ic J^c. 

Butter Ic J^c. 

Ice  cream 4c Ic. 

Coffee Ic ViO. 

Mnk  for  coffee Ic J^c. 

The  plan  might  be  roughly  stated  as  follows: — 

.02  service  charge  added  to  any  dish  costing  .05  to  .10. 
.01       "  "         "       "      "     "         "      0.2  to  .03. 

.01       "  "         "        "      "     "      or  combination  of 

dishes  costing  from  .01  to  .02. 

The  lunch  room  offers  many  opportunities  for  teaching  the 
principles  of  nutrition.  Where  the  full  lunch  is  provided  by 
the  company  without  cost  to  the  worker  it  may  be  made  a 
highly  nutritious  meal.  The  workers  will  partake  of  most 
of  the  dishes  and  will  be  assured  of  at  least  one  weU-bal- 
anced  meal  a  day.  They  are  more  liable  to  form  good  food 
habits  when  good  food  is  put  before  them.  On  the  other 
hand,  if  the  worker  pays  the  cost  of  the  food,  he  must  be 
free  to  buy  what  he  will.  He  may  wish  to  bring  part  of  his 
lunch  from  home  and  supplement  it  in  the  lunch  room. 
False  ideas  of  economy  or  perverted  taste  may  prevent  his 
buying  what  he  needs.  Some  lunch  room  managers  say  they 
cannot  educate  the  workers  in  the  choice  of  food,  but  others 
have  had  a  degree  of  success.  The  power  of  suggestion  plays 
an  active  part  here.  Sometimes  an  appeal  to  the  general 
desire  to  get  a  "bargain"  is  successful.  If  the  items  of  food 
are  charged  for  at  one  price  when  ordered  singly,  but  are  given 
at  a  noticeable  reduction  when  served  as  a  meal  in  specified 
combination,  many  workers  will  buy  a  proper  lunch  and  will 
unconsciously  form  the  habit  of  eating  a  good  meal. 

Industrial  nurses  and  dietitians  may  also  use  the  lunch 
room  and  its  equipment  as  a  class  room  in  which  to  give  to 
the  women  and  girls  instruction  in  the  care  of  their  homes  and 


FOOD  147 

children  and  in  food  preparation.  In  communities  where 
girls  go  to  work  at  fourteen,  often  not  having  reached  the 
sixth  grade,  they  have  Uttle  opportunity  for  learning  how  to 
keep  a  pleasant  home  and  to  set  a  good  economical  table. 
Almost  every  woman  Ukes  to  cook,  especially  if  she  has  an 
appreciative  father,  brother,  husband  or  sweetheart  to  feed. 
If  the  use  of  the  kitchen,  therefore,  with  hght,  heat  and 
equipment  is  allowed  for  an  hour  and  a  half  or  two  hours  after 
the  plant  closes,  cooking  and  housekeeping  classes  may  be 
formed  and  carried  on  without  any  further  expense  to  the 
company.  For  a  small  per  capita  cost  the  class  can  provide 
its  own  materials  and  dme  on  the  food  cooked.  Careful 
planning  of  the  lessons  will  make  this  possible  even  from 
the  first  day. 

Some  firms  distribute  circulars  of  advice  as  to  the  choice  of 
food  at  different  seasons  of  the  year,  but  the  real  value  of 
such  casual  means  of  instruction  is  open  to  debate. 

If  even  a  few  people  can  be  led  to  acquire  the  habit  of 
eating  good  food,  a  good  deal  has  been  accomplished.  If 
young  girls  can  be  taught  to  like  to  cook  and  care  for  a  house 
because  they  know  how,  the  health  of  the  next  generation 
will  be  largely  assured. 

There  are  a  number  of  books  which  will  help  the  industrial 
nurse  who  must  manage  a  lunch  room  and  who  can  use  its 
facihties  in  teaching  the  girls  to  cook.^ 

In  many  homes  the  visiting  industrial  nurse  must  teach 
dietetics  because  that  is  the  one  thing  needed  to  improve  the 
condition  of  the  adults,  maintain  the  health  of  the  children, 
and  perhaps  to  make  possible  the  natural  breast  feeding  of 
the  family  baby. 

In  dealing  with  people  from  other  lands  we  must  not  forget 

their  native  customs  and  preferences.     The  natural  food 

habits  of  any  race  which  produces  a  large  percentage  of 

healthy  individuals  are  probably  based  to  a  large  extent  on 

^  See  Bibliography  for  list  of  valuable  publications  which  will  help 
the  industrial  nurse  in  dealing  with  the  home  problems  of  the  workers. 
This  chapter  can  only  be  suggestive  of  the  possibilities  which  the  nurse 
will  find  for  service  in  this  field. 


148  INDUSTRIAL  NURSING 

sound  dietetic  principles.  It  would  be  folly  to  impose  a  diet 
of  baked  beans,  Boston  brown  bread,  apple  sauce,  and  plain 
boiled  beef  and  vegetables  on  the  Italian  who  has  thrived  for 
generations  on  green  leaves  of  many  kinds,  oil,  fruit,  pastini, 
cheese,  and  vegetables  and  meat  served  with  highly  seasoned 
sauces.  He  may  better  be  encouraged  in  getting  what  he 
likes.  The  danger  is  not  in  his  native  diet  but  in  the  expense 
or  scarcity  of  the  foods  to  which  he  has  been  accustomed. 
This  may  cause  him  to  adopt  other  and  less  wholesome 
habits  unless  he  is  made  acquainted  with  suitable  substitutes. 
Even  the  custom  of  giving  unsuitable  food  to  Kttle  babies  is 
not  conmaon  when  the  mother  has  food  she  likes  and  which 
nourishes  her,  as  her  baby  is  then  breast  fed  and,  being  com- 
fortable, he  does  not  cry  and  the  mother  does  not  strive  to 
quiet  him  by  fair  means  or  foul. 

The  Polish  people  coming  largely  from  farms  where  they 
had  milk,  cheese,  bread  from  the  whole  grain,  and  vegeta- 
bles in  abundance,  are  bewildered  at  the  cost  of  these  things 
in  cities.  The  women  have  worked  in  the  fields  at  home, 
spending  Httle  time  in  the  preparation  of  food.  Here  they 
work  in  the  mills  as  a  matter  of  course.  Instead  of  milk, 
cereals  and  vegetables — products  from  their  farms — pro- 
viding a  naturally  well-balanced  diet,  the  nearest  store 
offers  nice  white  bread,  cooked  meats,  nut  butter  and  coffee. 
These  foods  do  not  provide  adequately  for  the  growth  of 
their  children,  and  the  absence  of  bulky  foods  results  in 
sluggish,  disordered  digestion,  with  the  resulting  headaches 
and  other  symptoms  of  autointoxication. 

The  industrial  visiting  nurse  should  have  a  working 
knowledge  of  dietetics,  and  should  know  in  general  the  kinds 
of  foods  required  for  the  growth  of  children  and  the  health  of 
adults.  She  should  understand  the  sources  of  protein,  min- 
eral matter,  fats  and  fat  solubles,  and  carbohydrates,  and 
how  these  may  be  combined  in  our  common  foods  to  form  a 
nutritious  and  adequate  diet. 

We  must  teach  the  mother  the  value  of  her  work  in  the 
home;  we  must  foster  the  back  yard  garden  and  teach  the 


FOOD  149 

preservation  of  its  products;  we  must  show  the  value  of  milk 
(even  of  goat's  milk  if  there  is  room  for  a  goat) ;  we  must  not 
thrust  aside  as  of  no  value  any  racial  food  custom.  We  can 
soon  distinguish  between  habits  recently  acquired  through 
ignorance  or  for  convenience,  and  customs  of  proved  value. 
If  we  can  show  real  understanding  of  these  racial  customs  we 
will  often  get  a  hearing  in  our  efforts  to  introduce  more 
important  American  ideas.  If  we  can  introduce  the  Italian 
salad,  the  French  soup,  the  hard  whole- wheat  Swedish  bread 
and  the  Hungarian  stew  into  the  home  of  the  average  Ameri- 
can worker  we  will  do  a  national  service,  and  we  will  in  no 
way  retard  the  Americanization  of  the  foreigner  who  has 
added  to  the  variety  on  our  national  table. 

Attention  may  well  be  called  to  two  recent  publications 
which  deal  with  the  subject  of  the  industrial  canteen  and 
which  give  definite  information  concerning  this  problem. 
One  is  "Welfare  Work  in  British  Munition  Factories"  (see 
Bibliography)  which  considers  in  some  detail  Canteen  Con- 
struction and  equipment,  with  suggestions  as  to  suitable 
dietaries.  The  other  is  "Restaurant  Facilities  for  Shipyard 
Workers"  (see  Bibliography)  which  goes  thoroughly  into  the 
question  of  floor  plans,  equipment  and  menus  and  gives  re- 
ports from  various  industrial  concerns  throughout  the  country 
who  have  found  the  canteen  an  essential  part  of  their  work. 

For  a  study  of  food  values,  presented  in  such  a  way  that 
the  lay  person  may  easily  use  it  as  a  reference,  such  a  book  as 
that  by  Professor  M.  S.  Rose  on  "Feeding  the  Family"  is  of 
valuable  assistance.  Food  tables  are  given  showing  the 
nutritive  value  of  foods  by  "100  calorie  portion,"  method 
and  also  the  value  of  dishes  in  everyday  use.  "The  Newer 
Knowledge  of  Nutrition"  by  Professor  E.  V.  McCollum  is 
true  to  its  title  and  sets  forth  very  clearly  some  of  the  later 
data  that  has  been  worked  out  in  regard  to  the  essentials  of  a 
"protective  diet."  ^ 

^  Teachers  College,  Dept.  of  Household  and  Institution  Management 
will  be  glad  to  aid  the  industrial  nurse  in  pointing  her  to  sources  of  def- 
inite information  concerning  canteens  and  home  management  problems. 


CHAPTER  XIV 

A  FEW  QUESTIONS  WHICH  MAINLY  CONCERN  THE  INDUSTRIAL 
NURSE    HERSELF 

Before  taking  a  new  position,  an  industrial  nurse  will  do 
well  to  consider  certain  things  and  to  take  certain  precautions 
in  order  to  avoid  future  misunderstanding  or  disappoint- 
ment. Important  points  such  as  salary  and  any  promised 
increase,  vacations,  etc.,  should  be  stated  to  the  nurse  in 
writing  for  her  protection  in  any  future  change  of  adminis- 
tration. This  does  not  mean  a  contract  but  simply  a  letter 
confirming  the  decisions  reached  in  an  interview.  Most 
employers  and  nurses  consider  contracts  unwise.  No  nurse 
would  wish  to  remain  where  she  was  not  acceptable  and  no 
employer  would  wish  to  retain  a  nurse  who  was  dissatisfied. 
Of  course  an  understanding  as  to  reasonable  notice  of  leaving 
should  be  reached  and  no  nurse  is  justified  in  resigning,  for 
her  own  advantage,  any  position  until  she  has  so  organized 
her  work  that  it  may  be  carried  on  after  she  leaves  without 
setback  or  loss  of  efficiency.  She  will  be  judged  as  much  by 
what  she  leaves  as  by  what  she  has  done. 

The  nurse  may  be  engaged  by  the  busy  president  or  other 
official  of  a  company,  but  a  personal  interview  with  the  person 
at  the  plant  to  whom  she  is  to  be  responsible  is  most  de- 
sirable. The  nurse  will  then  have  a  chance  to  know  what  is 
expected  of  her  and  to  show  her  attitude  toward  the  work. 
Misunderstandings  may  come  from  the  omission  of  this 
precaution.  During  the  interview,  manager  and  nurse  should 
discuss  the  relation  of  the  nurse  to  the  company  physician, 
the  limitations  of  the  nurse  in  giving  medical  care  and,  to 
some  extent,  the  question  of  cooperation  with  other  depart- 
ments and  with  local  agencies.    It  is  unwise  to  crowd  too 

150 


THE  INDUSTRIAL  NURSE  HERSELF         151 

much  into  this  first  interview.  Its  main  advantage  is  that  it 
gives  each  a  chance  to  decide  if  they  have  the  same  general 
aims  and  can  reasonably  expect  to  work  in  harmony. 

A  preliminary  interview  with  the  company  physician  is 
desirable  for  exactly  the  same  reasons. 

The  nurse  must  take  care  that  she  shall  not  find  herself  in 
the  position  of  a  substitute  for  a  physician;  that  she  shall  not 
discover  after  beginning  her  work  that  the  person  to  whom 
she  is  directly  responsible  has  different  plans  from  those  of 
the  person  who  engaged  her;  that  she  shall  have  at  least  a 
reasonable  amount  of  cooperation  from  the  beginning  and 
that  she  shall  be  allowed  some  initiative. 

Too  much  must  not  be  expected  at  first.  The  nurse  must 
prove  herself  worthy  by  doing  well  what  her  employer  con- 
siders her  duties  before  she  can  reasonably  expect  others  to 
have  much  confidence  in  her  ability  for  wider  usefulness: 

An  inspection  of  the  plant  before  taking  a  position  is 
interesting  but  not  necessary  and  might  prove  discouraging. 
The  least  attractive  place  needs  the  nurse  more  than  one 
which  seems  ideal.  Much  that  seems  forbidding  to  an  out- 
sider takes  on  a  different  character  after  one  is  acquainted 
with  the  industry.  If  the  nurse  feels  sure  of  her  employer, 
of  the  general  manager,  welfare  superintendent  or  other 
member  of  the  staff  to  whom  she  is  to  be  responsible,  and  of 
the  company  physician,  she  may  safely  take  a  plunge  into  a 
new  position  without  much  further  investigation.  She  will 
be  saved  from  worrying  over  difficulties  she  may  never  have 
to  meet  if  she  confines  her  knowledge  of  the  plant  to  what  she 
is  told,  until  she  has  entered  the  work  and  is  in  a  position  to 
learn  for  herself.  The  hurried  inspection  of  a  large  plant 
leaves  one  confused,  but  the  slow  accumulation  of  a  little 
knowledge  each  day  gives,  in  time,  an  understanding  of  the 
industry. 

Some  nurses  may  wish  to  make  a  careful  inspection  of  the 
community.  Others,  more  courageous,  may  like  to  go  on  a 
voyage  of  discovery,  feeling  that  they  may  be  more  needed  in 
unattractive  places.    In  primitive  communities,  where  com- 


152  INDUSTRIAL  NURSING 

fortable  quarters  for  the  nurse  may  not  exist,  the  company 
employing  her  should  see  that  a  suitable  place,  at  least 
temporarily,  is  provided.  A  nurse  cannot  be  expected  to  do 
good  work  and  help  to  raise  the  living  standards  of  others 
unless  she  is  comfortable  herself.  The  fashion  in  some  mining 
villages  of  giving  the  nurse  a  company  house  and  a  salary  too 
small  to  afford  household  help  is  unfortunate.  Much  time 
must  be  spent  in  the  care  of  her  home  which  should  be  given 
to  her  work  or  which  she  needs  for  relaxation. 

The  question  of  dress  should  be  considered  before  taking  an 
industrial  position.  A  uniform  adds  dignity  to  the  nurse, 
makes  it  easy  for  the  workers  to  identify  her,  and  sets  a  good 
example  to  the  women  workers  by  demonstrating  a  dress 
suitable  to  the  work  to  be  done.  In  some  industries,  if  the 
nurse's  duties  are  confined  to  the  plant  or  if  she  has  time  to 
change  before  and  after  going  out,  a  regulation  white  uniform 
or  the  nurse's  school  uniform  is  practical.  In  mills,  however, 
where  there  is  moving  machiner}'^  and  where  the  nurse  may 
have  to  go  out  of  doors  to  reach  different  parts  of  the  plant, 
spreading  caps  and  flying  skirts  and  aprons  may  be  a  danger 
and  are  better  kept  for  the  first  aid  room.  A  nurse  going 
among  moving  machinery  may  soon  find  it  one  of  her  duties 
to  impress  upon  women  and  girls  the  necessity  of  closely 
fitting  uniforms,  smoothly  dressed  hair  and  closely  fitting 
caps,  and  she  should  set  them  an  example  by  making  her 
own  uniform  fit  the  work  she  is  doing. 

A  busy  nurse  working  both  in  the  plant  and  visiting  in  the 
homes  and  perhaps  driving  and  sometimes  repairing  an  auto- 
mobile, cannot  keep  a  white  uniform  in  a  presentable  condi- 
tion and  she  cannot  find  the  time  for  the  many  changes  neces- 
sary if  it  is  kept  for  indoor  use.  Furthermore,  workers 
sometimes  object  to  having  a  nurse  in  uniform  call,  when,  if 
she  is  inconspicuously  dressed,  they  will  welcome  her.  This 
may  be  a  benighted  view  but  is  pardonable  in  towns  where 
the  visiting  nurses  have  the  name  of  being  charity  workers. 

A  standardized  dress,  coat  and  hat  characteristic  of  the  in- 
dividual industrial  nurse  or  nurses  of  the  plant  but  not  recog- 


THE  INDUSTRIAL  NURSE  HERSELF         153 

nizable  as  specially  belonging  to  visiting  nursing  solves  the 
problem  for  many  nurses  in  industry.  The  dress  should  be 
washable,  with  white  collar  and  cuffs  and  the  coat  and  simple 
hat  of  the  same  color  as  the  dress.  The  nurse  will  then  be 
able  to  wear  her  uniform  to  and  from  her  home  and  be  suit- 
ably and  inconspicuously  dressed  in  the  plant,  on  the  street 
and  in  the  homes  of  the  workers.  Care  will  be  needed  in 
choosing  the  material  for  the  dress.  It  must  not  specially 
suggest  nursiag.  Nurses  in  mills  have  found  gray  hnen  of 
a  mixed  weave  satisfactory.  Grey  Japanese  crepe  and  gray 
cotton  pophn  have  been  used,  and  in  department  stores  dark 
blue  washable  sOk  has  been  worn.  A  standard  material  is 
best  because,  once  a  suitable  dress  is  planned,  it  is  better 
not  to  change  it. 

When  the  growth  of  the  work  makes  an  assistant  nurse 
necessary  the  employer  should  be  willing  to  allow  the  senior 
nm-se  to  have  a  voice  in  choosing  the  person  with  whom  she 
will  have  to  work  and  with  whom  she  may  be  obliged  to  live. 
The  senior  nurse  should  at  least  have  an  interview  alone  with 
the  candidate  before  she  is  engaged,  and  the  work  will  gain 
much  if  she  is  allowed  to  find  and  engage  her  with  the  ap- 
proval of  her  employer.  It  is  sometimes  thought  that  such  a 
position  should  be  given  to  some  young  woman  who  has 
grown  up  in  the  community.  While  such  a  person  has  the 
advantage  of  knowing  the  people  and  the  geography  of  the 
town,  and  of  having  relatives  and  friends  at  hand,  it  is  the 
exception,  in  a  small  town,  to  find  a  nurse,  no  matter  how 
fine  and  desirable  she  may  be,  who  can  enter  the  homes  of 
people  among  whom  she  has  grown  up  and  gain  their  con- 
fidence and  appreciation  with  the  same  readiness  as  some 
one  unfamiliar  with  the  history  of  those  whom  she  visits. 

The  assistant,  having  been  chosen,  deserves  the  best  that 
her  senior  can  give  her  in  opportunities  for  present  service 
and  in  preparation  for  wider  usefulness.  She  should  have  an 
opportunity  to  learn  all  that  the  senior  has  learned  and  she 
will  learn  more  readily  by  taking  advantage  of  her  senior's 
experience . 


154  INDUSTRIAL  NURSING 

She  should  be  free  to  make  suggestions  for  the  betterment 
of  the  work  and  the  employer  should  know  when  improve- 
ment has  been  made  possible  by  her  efforts.  A  little  state- 
ment of  the  work  of  the  assistant  nurse  may  be  gracefully 
included  in  the  regular  nonstatistical  reports.^ 

For  her  part  the  assistant  nurse  owes  absolute  loyalty  and 
cooperation  to  her  senior  and  should  keep  her  informed  of 
all  she  does  or  learns  which  may  affect  their  work  in  any  way. 

With  the  present  shortage  of  public  health  nurses,  an  as- 
sistant industrial  nurse  should  consider  that  she  is  serving 
an  apprenticeship  and  should  take  every  opportunity  to 
increase  her  knowledge  and  develop  her  powers  so  that  she 
may  be  able  to  take  advantage  of  the  many  opportunities 
for  independent  work.  The  senior  nurse  should  make  it  her 
business  to  see  that  the  junior  has  such  opportunities  as  soon 
as  she  is  able  to  assume  the  responsibihty.  The  inconvenience 
of  teaching  a  new  assistant  should  be  repaid  in  the  satisfac- 
tion of  having  helped  to  equip  another  industrial  nurse. 

If  there  are  two  or  more  industrial  nurses,  the  work  will 
necessarily  be  planned  by  the  one  in  charge,  who  will  find  a 
division  of  inside  and  outside  work  advisable.  By  this  means 
both  nurses  understand  all  that  is  being  done  and  each  will 
be  able  to  do  the  work  of  the  other  or  to  instruct  a  new  nurse 
in  case  of  sudden  and  unavoidable  changes.  No  executive 
is  really  efficient  who  has  no  understudy.  However  capable 
she  may  be  and  however  well  she  may  personally  manage 
her  department,  the  real  test  of  efficiency  comes  on  the  day 
she  is  suddenly  forced  to  remain  away  from  the  plant.  The 
real  executive  is  the  one  whose  department  will,  in  her  ab- 
sence, continue  to  run  smoothly  and  which  will  automatically 
absorb  a  new  worker  with  little  friction  or  inconvenience. 
This  means,  in  a  large  nursing  department,  a  head  nurse  who 
is  in  charge  of  all  other  nurses  and  of  the  nursing  and  all  allied 
activities. 

The  plan  of  having  several  nurses  with  distinct  duties 
and  no  supervising  nurse  is  wasteful  of  time,  prevents  the 
^  See  Chapter  X,  Records  and  Reports. 


THE  INDUSTRIAL  NURSE  HERSELF         155 

possibility  of  giving  experience  to  young  nurses,  destroys 
unity  of  plans,  purpose  and  results,  and  makes  unexpected 
changes  of  personnel  times  of  confusion  and  friction  with  the 
resulting  chance  of  workers  being  neglected.  Much,  that  has 
been  so  carefully  built  up,  may  also  at  these  times  be 
destroyed  through  the  ignorance  or  inexperience  of  those 
suddenly  compelled  to  assume  unaccustomed  reponsibihties. 
Large  corporations,  with  branch  plants  in  several  locaHties, 
sometimes  employ  a  supervising  nurse  whose  responsibUity 
is  the  management  of  nursing  service  for  all  plants.  This  is 
necessarily  almost  purely  executive  work,  although  the  or- 
ganization of  the  service  in  each  plant  will  require  the  presence 
and  active  assistance  at  the  beginning  of  the  supervising 
nurse.  Employment  of  this  sort  offers  many  opportunities 
in  setting  a  high  standard  for  industrial  nursing  and  in  work- 
ing out  practical  uniform  methods.  The  service  may  be  so 
planned  as  to  be  practically  unaffected  by  changes  of  per- 
sonnel. The  comparative  records  and  reports  of  such  a 
supervising  nurse  may  be  made  of  more  value  than  those  of 
isolated  nurses  working  alone.  The  visits  of  a  supervising 
nurse  may  mean  much  to  the  nurses  in  outlying  plants  by 
keeping  them  in  touch  with  what  others  are  doing,  giving 
them  the  benefit  of  the  viewpoint  of  a  more  experienced 
woman  and  by  the  real  help  of  the  supervisor  in  the  solution 
of  their  problems. 


CHAPTER  XV 

WHAT   INDUSTRIAL   NURSING   OFFERS   TO   THE   NURSE 

No  one  will  question  the  statement  that  the  nurse  can  give 
much  to  industry.  Let  us  see  what  the  world  of  industry 
offers  to  the  nurse.  She  should  expect  something  in  the  way 
of  special  advantages,  personal  development,  health,  happi- 
ness and  financial  reward  and  preparation  for  future  oppor- 
tunities. 

The  continual  contact  with  people  of  all  sorts,  most  of 
whom  are  not  ill,  gives  the  nurse  who  can  see  through  the  eyes 
of  others,  a  wide  view  point.  The  fact  that  so  large  a  number 
of  those  she  sees  have  normal  minds  and  bodies  causes  her 
to  react  to  people  in  a  clearer  headed  and  more  normal  way 
than  is  possible  for  a  nurse,  surrounded  during  her  working 
hours  solely  by  the  sick  and  those  concerned  with  them.  To 
the  nurse  more  interested  in  health  than  in  abnormalities, 
this  is  an  advantage  to  be  prized  not  only  for  its  effect  on 
herself  but  for  what  it  enables  her  to  bring  to  the  sick. 

Work  in  the  business  world  is  valuable  training  for  a  nurse. 
It  teaches  her  method  and  exactness.  It  tempers  her  im- 
pulses and  develops  her  sense  of  justice  and  of  relative  values. 
It  teaches  her  the  fundamental  likeness  of  all  people  while 
training  her  to  recognize  their  individual  characteristics  and 
to  treat  them  as  persons  rather  than  cases. 

It  is  healthy  work,  physically  as  well  as  mentally,  unless 
the  nurse  falls  into  the  temptation  of  trying  to  do  more  than 
she  is  physically  able  to  stand.^  If  she  yields  to  this  tempta- 
tion she  will  soon  find  herself  unable  to  do  anything.  While 
in  some  industries  the  hours  are  still  long,  they  are  usually 
regular;  there  should  be  no  night  work;  and  Saturday  after- 

1  See  Miss  Mary  S.  Gardner's  "  Public  Health  Nursing,"  page  157. 

156 


INDUSTRIAL  NURSING  AND  THE  NURSE     157 

noon,  Sunday  and  holidays  are  usually  free.  Where  home 
visiting  is  done  there  is  the  advantage  of  some  time  spent  out 
of  doors.  Much  walking  from  patient  to  patient  is  so  waste- 
ful of  time  that  many  employers  provide  an  automobile  which 
the  nurse  drives.  This  is  a  means  of  rest  and  pleasure  to  the 
nurse  unless  the  traffic  conditions  of  a  city  make  it  a  source 
of  additional  nervous  strain.  But  even  in  a  city  a  car  does 
so  much  to  save  time,  exposure  and  fatigue  to  every  industrial 
nurse  who  works  in  or  visits  the  homes,  that  it  must  be  con- 
sidered almost  a  necessity.  In  large  cities  home  visiting 
may  mean  many  stairs  to  climb;  small  towns  with  detached 
houses  are  free  from  this  drawback. 

Industrial  nursing,  while  not  free  from  discouraging  fea- 
tures, is  on  the  whole  happy  work,  in  which  conditions  im- 
prove and  results  are  obtained,  and  in  which  service  is  repaid 
by  confidence  and  often  affection. 

Any  statement  as  to  the  financial  returns  from  industrial 
nursing  made  at  the  present  time  (1919)  may  have  Httle  bear- 
ing on  the  future.  Exact  information  is  not  easy  to  obtain 
as  many  salaries  are  considered  by  the  employer  as  confiden- 
tial. It  seems  safe,  however,  to  say  that  the  salary  of  an  as- 
sistant nurse  may  be  expected  to  exceed  somewhat  that  of  a 
staff  nurse  of  a  visiting  nurse  association.  The  salary  of  a 
nurse  organizing  industrial  nursing  or  holding  an  important 
executive  position  wiU  depend  largely  on  her  abiUty  to  earn 
her  money.  In  the  business  world  proved  abihty  is  generally 
recognized.  Living  expenses  are  seldom  included,  although 
living  quarters  are  sometimes  provided.  Uniforms  are,  as  a 
rule,  not  provided.  Uniforms  are  sometimes  laundered  and 
when  the  nurse  must  change  after  reaching  the  plant  this 
service  is  a  great  convenience  to  her.  But  if  this  involves  dis- 
cussion it  is  more  dignified  for  the  nurse  to  be  as  independent 
in  this  as  in  other  personal  matters.  Vacations  with  pay  are 
usually  allowed  and  the  salary  is  almost  always  continued 
during  short  illnesses.  An  industrial  nurse  must  usually 
make  provision  for  her  own  hospital  care  if  she  should  need  it. 

No  nurse  joining  the  ranks  of  industrj'  at  the  present  time 


158  INDUSTRIAL  NURSING 

(1919)  need  feel  that  she  is  entering  a  crowded  field.  Be- 
cause there  are  not  enough  industrial  nurses,  untrained  and 
half- trained  women  are  attempting  highly  technical  and  re- 
sponsible work.  Industrial  nursing  is  not  a  ''blind  alley  oc- 
cupation." Opportunities  abound.  A  nurse  building  on  a 
thorough  preparation  with  an  open-minded  attitude  toward 
her  work  should  not  fail  to  advance  as  far  in  industrial  nurs- 
ing as  in  any  other  branch  of  the  nursing  profession. 

With  the  reahzation  of  more  ideal  social  and  industrial 
relations  the  industrial  nurse  of  executive  ability  will,  with- 
out doubt,  find  her  services  in  greater  demand  under  health 
insurance  laws  and  in  organizations  and  industries  where 
full  understanding  and  cooperation  between  employer  and 
employe  give  each  an  equal  voice  in  the  pursuit  of  their 
common  aims. 

While  the  industrial  nurse,  with  others,  will  gain  strength 
and  inspiration  by  membership  and  active  participation  in 
the  various  nursing,  public  health,  social  welfare  and  safety 
organizations,  state,  local  and  national,  she  must  also  realize 
that  her  special  work  gives  her  an  exceptional  and  valuable 
experience,  and  she  should  be  willing  to  share  this  with  other 
nurses  who  have  not  the  same  opportunities.  Pupil  nurses 
should  be  given  an  idea  of  the  opportunities  awaiting  them 
in  the  industrial  field.  Other  public  health  nurses  need  the 
knowledge  the  industrial  nurse  gains  so  easily  of  the  normal 
condition  of  the  people  she  deals  with,  their  racial  peculiari- 
ties and  the  relation  of  environment  and  emplo3mient  to 
health.  The  industrial  nurse  should  give  as  generously  of 
her  experience  and  allow  as  much  of  her  work  to  be  seen  by 
those  interested  as  is  permitted  by  her  employer.  She  owes 
a  duty  to  her  training  school,  to  her  alumnse  association, 
to  the  National  Organization  for  Public  Health  Nursing; 
she  can  only  discharge  this  duty  by  taking  an  active  part  in 
meetings,  serving  on  committees  and  doing  whatever  else 
lies  in  her  power  to  further  the  broader  cause  of  public  health 
nursing. 


APPENDIX 

First  Aid  Rules 

If  the  industrial  nurse  needs  a  guide  for  first  aid,  the  following 
"  Instructions  to  Laymen  for  First  Aid  Treatment  of  Common  In- 
juries and  Disorders,"  copyright  1914  by  Conference  Board  on 
Safety  and  Sanitation,  are  excellent.  They  are  included  by  special 
permission  of  Mr.  Mangus  W.  Alexander,  Managing  Director, 
National  Industrial  Conference  Board. 

SAFETY  BULLETIN  NO    17,  NATIONAL  FOUNDER'S 
ASSOCIATION 

Wounds  that  Bleed 

Abrasions,  Cuts,  Punctures 

Drop  3%  Alcoholic  Iodine  into  wound  freely,  then  apply  dry 
sterile  gauze  to  wound  and  bandage  it.  Do  not  otherwise  cleanse 
wound. 

Severe  Bleeding 

Place  patient  at  rest  and  elevate  injured  part.  Apply  sterile 
gauze  pad  large  enough  to  allow  pressure  upon,  above  and  below 
wound.    Bandage  tightly. 

If  severe  bleeding  continues  apply  tourniquet  between  wound 
and  heart  and  secure  doctor's  services  at  once.  Use  tourniquet 
with  caution  and  only  after  other  means  have  failed  to  stop  bleeding. 

Nose  Bleeding 

Maintain  patient  in  upright  position  with  arms  elevated.  Have 
him  breathe  gently  through  mouth  and  not  blow  nose.  If  bleed- 
ing continues  freely  press  finger  firmly  on  patient's  upper  lip  close 
to  nose  or  have  him  snuff  diluted  White  Wine  Vinegar  into  nose. 

159 


160  APPENDIX 

Injuries  Which  Do  Not  Bleed 

Bruises  and  Sprains 

Cover  injury  with  several  layers  of  sterile  gauze  or  cotton,  then 
bandage  tightly.  AppUcation  of  heat  or  cold  may  help,  other 
means  are  imnecessary.  If  injury  is  severe  place  patient  at  rest 
and  elevate  injured  part  untU  doctor's  services  are  secured. 

Eye  Injuries 
Except  Eye  Burns 

For  ordinary  eye  irritations  flood  eye  with  4%  Boric  Acid  Solu- 
tion. Remove  only  loose  particles  which  can  be  brushed  off  gently 
with  absorbent  cotton  wrapped  around  end  of  toothpick  or  match. 

Do  not  remove  foreign  bodies  stuck  in  the  eye.  In  that  case 
and  for  other  eye  injuries  drop  Castor  Oil  freely  into  eye,  apply 
sterile  gauze,  bandage  loosely  and  send  patient  to  doctor. 

Splinters  or  Slivers  Embedded  in  Skin 

Except  in  Eyes 

If  easily  reached  withdraw  with  tweezers,  then  treat  same  as 
"Wounds  that  Bleed";  otherwise  let  doctor  attend  to  it. 

Fire  Burns,  Electrical  Burns  and  Sunburn 

Do  not  open  blisters.  Use  Bum  Ointment  (3%  Bicarbonate  of 
Soda  in  Petrolatum)  freely  on  sterile  gauze  applied  directly  to 
bum.  Cover  with  several  thicknesses  of  flannel  or  other  soft  ma- 
terial, then  bandage  but  not  tightly. 

Acid  Burns 

Thoroughly  flush  wound  with  water,  then  dry  wound,  apply 
Bum  Ointment  and  bandage  as  above. 

Alkaline  Burns 

Thoroughly  flush  wound  with  water,  then  flood  with  White 
Wine  Vinegar  to  neutralize  (dilute  vinegar  for  alkaline  eye  bums), 
dry  wound,  apply  Burn  Ointment  and  bandage  as  above. 

Eye  Burns 
Treat  in  the  same  maimer  as  other  bums. 


APPENDIX  161 

Dislocations 

In  case  of  dislocation  of  finger  except  second  joint  of  thumb,  grasp 
finger  firmly  and  pull  it  gently  to  replace  joint,  then  place  finger  in 
splint  and  bandage  it.  In  all  other  cases  place  dislocated  part  at  rest 
and  promptly  secure  doctor's  services. 

Fractuees 

Make  patient  comfortable  and  secure  doctor's  services  at  once. 
Avoid  unnecessary  handUng  to  prevent  sharp  edges  of  broken 
bones  tearing  artery.  If  patient  must  be  moved  place  broken  limb 
in  as  comfortable  position  as  possible  and  secure  it  by  splint. 

In  case  of  severe  bleeding  apply  sterile  gauze  and  follow  direc- 
tions under  "Severe  Bleeding." 

Dizziness,  Headache,  Nausea 

Give  patient  teaspoonful  of  Aromatic  Spirit  of  Ammonia  in  hot 
or  cold  water. 

Chills  and  Cramps 

Give  patient  20  to  30  drops  of  Jamaica  Ginger  in  hot  or  cold 
water.    If  improvement  is  not  speedily  obtained  send  for  doctor. 

Frost  Bites 
Rub  with  ice,  snow  or  cold  water,  then  treat  as  "Fire  Bums." 

Insect  Bites 
Treat  as  "Wounds  that  Bleed." 

Internal  Poisoning 

Immediately  secure  doctor's  services.  Make  patient  drink  large 
quantities  of  water,  preferably  warm,  and  make  him  vomit  by  stick- 
ing one's  finger  down  his  throat  or  by  other  means. 

Heat  Prostration 

Give  patient  teaspoonful  of  Aromatic  Spirit  of  Ammonia  in  hot 
or  cold  water.    In  case  body  feels  warm  apply  cold  to  it ;  if  necessary 


162  APPENDIX 

give  cold  bath.    In  case  body  feels  cold  and  clammy,  apply  heat 
to  it  and  inunediately  send  for  doctor. 

Unconsciousness  from  Fainting 

Lay  patient  on  his  belly  and  turn  his  face  to  one  side.  Loosen 
all  tight  clothing.  Remove  false  teeth,  tobacco,  etc.,  from  mouth. 
Apply  cold  to  head,  wannth  to  hands  and  feet.  If  breathing  stops, 
treat  patient  as  directed  under  "Electric  Shock."  Give  no  liquids 
by  mouth  until  patient  is  fully  conscious.  Then  give  teaspoonful 
of  Aromatic  Spirit  of  Ammonia  in  hot  or  cold  water. 

Shock,  Following  Injury 

In  case  shock  is  due  to  severe  bleeding  control  it  first  as  directed, 
under  "Severe  Bleeding"  and  summon  a  doctor. 

Lay  patient  flat  on  back  and  keep  him  warm  with  blankets, 
hot-water  bottles,  etc.,  and  provide  plenty  of  fresh  air.  Let  patient 
inhale  fumes  of  Aromatic  Spirit  of  Ammonia.  If  fully  conscious, 
give  patient  hot  drink  or  teaspoonful  of  Aromatic  Spirit  of  Am- 
monia in  hot  or  cold  water. 

Unconsciousness  from  Asphyxiation  by  Gas,  Smoke  or  Water 
Treat  patient  as  directed  under  "Electric  Shock." 

Electric  Shock 

Immediately  free  patient  from  electrical  circuit  using  every  care 
to  protect  one's  self  against  electric  shock.  Then  if  patient  is  un- 
conscious, even  if  he  appears  dead,  lay  him  on  his  belly  with  arms 
extended  forward,  turn  his  face  to  one  side,  remove  false  teeth, 
tobacco,  etc.,  from  his  mouth  and  draw  his  tongue  forward. 

Kneel,  straddling  patient's  thighs,  facing  his  head,  and  resting 
your  hands  on  his  lowest  ribs.  Swing  forward  and  gradually  bring 
weight  of  your  body  upon  your  hands  and  thus  upon  patient's 
back,  then  immediately  remove  pressure  by  swinging  backward. 
Repeat  this  movement  about  twelve  times  per  minute  without 
interruption  for  hours  if  necessary,  until  natural  breathing  has  been 
started  and  maintained  (see  cuts). 

Meanwhile  send  for  a  doctor,  have  patient's  tight  clothing  loos- 
ened, keep  him  warm  and  provide  plenty  of  fresh  air.  Do  not  give 
patient  liquids  by  mouth  until  he  is  fully  conscious. 


APPENDIX 


163 


FIG.  I— INSPIRATION 
PRESSURE  OFF 


FIG.  a-EXPIRATIONsl 
PRESSURE  ON 


Plate  D 


\ 


SOURCES   OF  INFORMATION 

ON   MANY  PUBLIC  HEALTH  AND  SOCIAL  PROBLEMS 
ENCOUNTERED  BY  THE  INDUSTRIAL  NURSE 

American  Social  Hygiene  Association,  105  W.  40th  St.,  N.  Y.  C. 
Object:  For  the  repression  of  prostitution,  the  reduction  of 
venereal  disease,  and  the  promotion  of  sound  sex  education. 
Information  and  catalogue  of  pamphlets  upon  request. 
Associate  membership,  $2.00,  annual,  $5.00,  sustaining, 
$10.00.  Memberships  include  quarterly  magazine  and 
monthly  bulletin. 

American  Society  for  the  Control  of  Cancer,  25  W.  45th  St.,  N.  Y. 
C,  Miss  Marion  H.  Mapelsden,  acting  executive  secretary. 
Object:  To    disseminate    knowledge    concerning    symptoms, 
diagnosis,  treatment  and  prevention.    Publications  free  on 
request.    Annual  membership  dues,  $3.00. 

National  Child  Labor  Committee,  105  E.  22nd  St.,  N.  Y.  C,  Owen 
R.  Lovejoy,  Secretary  (35  State  Branches). 
Industrial  and  agricultural  investigations;  legislation;  studies  of 
administration  education;  delinquency;  health;  recreation, 
children's  codes.  Published  quarterly  "Child  Labor  Bulle- 
tin."   Photographs,  slides  and  exhibits. 

National  Child  Welfare  Association,  70  Fifth  Ave.,  N.  Y.  C,  Chas. 
F.  Powlison,  General  Secretary. 
Originates  and  publishes  exhibit  material  which  visuaUzes 
conditions  affecting  the  health  and  education  of  children. 
Cooperates  with  communities,  educators  and  organizations 
through  exhibits,  child  welfare  campaigns,  etc. 

165 


166  SOURCES  OF  INFORMATION 

National  Committee  for  Mental  Hygiene,  50  Union  Square,  N.  Y. 
C,  Clifford  W.  Beers,  Secretary. 
Pamphlets  on  mental  hygiene,  mental  disorders,  feeble- 
mindedness, epilepsy,  inebriety,  criminology,  war  neuroses 
and  reeducation,  social  service,  backward  children,  surveys, 
state  societies.    Mental  Hygiene,  quarterly,  $2.00  a  year. 

National  Committee  for  Prevention  of  Blindness,  130  E.  22nd  St., 
N.  Y.  C,  Edward  M.  Van  Cleve,  Managing  Director,  Gordon 
L.  Berry,  Field  Secretary,  Mrs.  Winifred  Hathaway, 
Secretary. 
Objects:  To  furnish  information,  exhibits,  lantern  shdes,  lec- 
tures, pubUsh  Uterature  of  movement,  sample  free,  quantities 
at  cost.    Includes  N.  Y.  State  Committee. 

National  Conference  of  Social  Work,  Julia  C.  Lathrop,  President, 
Washington,  D.  C,  Wm.  T.  Cross,  General  Secretary,  315 
Plymouth  Court,  Chicago,  III. 

General  organization  to  discuss  principles  of  humanitarian 
effort  and  increase  efficiency  of  agencies.  Publishes  pro- 
ceedings annual  meetings.  Monthly  bulletin,  pamphlets, 
etc.   Information  bureau.    Membership,  $3.00. 

Children,  Henry  W.  Thurston. 

DeUnquents  and  Correction,  Cyrus  B.  Adams. 

Health,  Dr.  C.  E.  A.  Winslow. 

Public  Agencies  and  institutions,  Albert  S.  Johnstone. 

The  Family,  Joanna  C.  Colcord. 

Industrial  and  economic  problems,  Mrs.  Florence  Kelley. 

The  local  community,  Frances  Ingram. 

Mental  Hygiene,  Maj.  Frankwood  E.  Wilhams,  M.  0.  R.  C. 

Organization  of  social  forces,  WiUiam  J.  Morton. 

Uniting  native  and  foreign  bom  in  America,  Graham  Taylor. 

National  Organization  for  Public  Health  Nursing,  156  Fifth  Ave., 
N.  Y.  C,  Ella  PhilHps  Crandall,  Executive  Secretary. 
Object:  To  stimulate  the  extension  of  pubUc  health  nursing; 
to  develop  standards  of  technique;  to  maintain  a  central 
bureau  of  information.  Official  organ.  The  Public  Health 
Nurse;  subscription  included  in  membership.  Dues,  $2.00 
and  upward. 


SOURCES  OF  INFORMATION  167 

Playground  &  Recreation  Association,  1  Madison  Ave,.  N.  Y.  C, 
H.  S.  Braucher,  Secretary. 
Playground  and  community  center  activities  and  administra- 
tion. 

Red  Cross  Institute  for  Crippled  &  Disabled  Men,  311  Fourth  Ave., 
N.  Y.  C,  Douglas  McMurtrie,  Director. 
Maintains  industrial  training  classes  and  an  employment 
bureau  for  crippled  men.  Conducts  research  in  reeducation 
for  disabled  soldiers  and  industrial  cripples.  Publishes 
reports  and  reconstruction  work  here  and  abroad,  and  en- 
deavors to  establish  an  enlightened  public  attitude  towards 
the  physically  handicapped. 

Russell  Sage  Foundation,  For  the  Improvement  of  Living  Condi- 
tions, 130  E.  22nd  St.,  N.  Y.  C,  John  M.  Glenn,  Director. 
Departments:  Charity  Organization,  Child  Helping  Education, 
Statistics,  Recreation,  Remedial  Loans,  Surveys,  and  Ex- 
hibits, Industrial  Studies,  Library,  Southern  Highland 
Division. 

State  &  Municipal  Departments  of  Health,  and  State  Labor  De- 
partments. 

U.  S.  Dept.  of  Labor,  Industrial  conditions,  hazards,  disease,  labor 
laws,  Washington,  D.  C. 

U.  S.  Dept.  of  Labor,  Children's  Bureau,  Maternal  and  child  welfare 
and  laws  regulating  the  same,  Washington,  D.  C. 

U.  S.  PubUc  Health  Service,  Washington,  D.  C. 

Young  Women's  Christian  Association,  National,  600  Lexington 
Ave.,  N.  Y.  C. 
To  advance  physical,  social,  intellectual,  moral  and  spiritual 
interests  of  young  women.  Student,  city,  town,  and  county 
centers;  physical  education,  camps,  rest  rooms,  lunch  rooms, 
and  cafeterias;  educational  classes;  employment,  Bible  study; 
secretarial  training  school;  foreign  work;  war  work  councils. 


BIBLIOGRAPHY 

GENERAL 

Alexander,  M.  W.:  Hiring  and  Firing,  N.  Y.,  Nat'l  Assn.  of  Mfrs., 

1915. 
Antin,  Mary:  The  Promised  Land,  N.  Y.,  Houghton,  1912, 
Balch,  E.  G.:  Our  Slavic  Fellow  Citizen,  N.  Y.,  Charities  Pub. 

Comm.,  1910. 
Bergey,  D.  H.:  Principles  of  Hygiene,  5th  ed.,  revised,  Phila., 

Saunders,  1914. 
Brainard,  Annie  M.:  Organization  and  Administration  of  Public 

Health  Nursing,  Macmillan,  1919. 
Broadhurst,  Jean:  Home  and  Community  Hygiene,  Phila.,  Lippin- 

cott,  1918. 
Byington,  M.  F.:  The  Homestead,  N.  Y.,  Charities  Pub.  Comm., 

1910. 
Cabot,  R.  C:  Social  Serrice  and  the  Art  of  Healing,  N.  Y.,  Moffat, 

1909. 
Cadbury,  Edward:  Experiments  in  Industrial  Organization,  N.  Y., 

Longmans,  1913. 
Connor,  Ralph:  The  Foreigner,  N.  Y.,  Doran,  1909,  also  N.  Y., 

Grosset,  1911. 
.Devine,  E.  T.:  Misery  and  its  Causes,  N.  Y.,  Macmillan,  1909,  also 

N.  Y.,  Macmillan,  1913. 
Devine,  E.  T.:  Principles  of  Relief,  N.  Y.,  Macmillan,  1904. 
Dickinson,  S.  C:  What  to  Do  with  the  Other  Eight  Hours,  Arizona 

State  Bureau  Mines,  Bulletin  68,  Welfare  Series  1,  1917. 
Drury,  H.  B.:  Scientific  Management:  a  History  and  a  Criticism, 

N.  Y.,  Longmans,  1915. 
Dunton,  W,  R. :  Reconstruction  Therapy,  N.  Y.,  Macmillan,  1919. 
Fisher,  Boyd:  Industrial  Loyalty,  its  Value,  its  Creation,  its  Preserva- 
tion, London,  Eng.,  Rutledge,  1918. 
Fisher,  Irving:  Bulletin  30   of  the   Committee  of  One  Hundred  on 

National  Vitality,  its  Waste  and  Conservation,  Govt.  Printing 

Office,  Washington,  D.  C,  1910. 
Gardner,  M.  S.:  Public  Health  Nursing,  N.  Y.,  Macmillan,  1916. 

160 


170  BIBLIOGRAPHY 

Hayden,  George  and  Alice:  Throw  Physic  to  the  Dogs,  N.  Y.,  Doran, 
1918.  (Useful  handbook  on  the  avoidance  and  cure  of  constipa- 
tion.) 

Hay  hurst,  E.  A. :  Survey  of  Industrial  Health,  Hazards  and  Occupa- 
tional Diseases  in  Ohio,  10  pages,  Columbus,  Ohio,  State  Bd. 
of  Health,  1914. 

Kelley,  Florence:  Modern  Industry,  N.  Y.,  Longmans,  1914. 

Kelly,  R.  W.:  Hiring  the  Worker,  N.  Y,,  Industrial  Management 
Co. 

Kober,  G.  M.,  and  Hanson,  W.  C:  Diseases  of  Occupation  and 
Vocational  Hygiene,  Phila.,  Blackiston,  1916.  (Valuable  refer- 
ence book  for  the  industrial  nurse.) 

Ogden,  H.  N.:  Rural  Hygiene,  N.  Y.,  Macmillan,  1911. 

Price,  G.  M.:  Modern  Factory,  N.  Y.,  J.  Wiley  &  Sons,  1914. 

Pyle,  W.  L.:  Manual  of  Personal  Hygiene,  7th  ed.,  revised,  Phila., 
Saunders,  1917. 

Richards,  E.  H.:  Cost  of  Cleanness,  N.  Y.,  Wiley,  1908. 

Rosenau,  M.  J.:  Preventive  Medicine  and  Hygiene,  3rd  ed.,  N.  Y., 
Appleton,  1917. 

Spooner,  H.  T.:  Industrial  Fatigue  in  its  Relation  to  Maximum 
Output,  London,  Author,  1917. 

Steiner,  E.  A.:  On  the  Trail  of  the  Immigrant,  N.  Y.,  Revell,  1906. 

Stelzle,  Charles:  Letters  from  a  Working  Man,  by  an  American 
Mechanic,  N.  Y.,  Revell,  1908. 

Tolman,  W.  H.,  Guthrie,  A.  W.:  Hygiene  for  the  Worker,  N.  Y., 
American  Book  Co.,  1912. 

U.  S.  Dept.  of  Labor:  Employers'  Welfare  Work:  Bulletins,  1,  2,  3, 
Washington,  D.  C. 

U.  S.  Dept.  of  Labor:  Proceedings  of  the  Employment  Managers' 
Conference,  Bulletin  227,  Washington,  D.  C,  Phila.,  April  2,  3, 
1917. 

U.  S.  Dept.  of  Labor:  Welfare  Work  in  British  Munition  Factories, 
Bulletin  222,  Washington,  D.  C. 

Veiller,  L.  T.:  Housing  Problem,  Phila.,  American  Academy  of 
Science,  1905. 

Wald,  L.  D.:  House  on  Henry  Street,  N.  Y.,  Holt,  1915. 

Watkins,  G.  P.:  Welfare  as  an  Economic  Quantity,  N.  Y.,  Houghton, 
1915. 

Winslow,  C.  E.  A.:  Health  of  the  Worker,  N.  Y.,  Metropolitan  Life 
Insur.  Co.,  1913. 


BIBLIOGRAPHY  171 

CHILD  HYGIENE 

Dickinson,  M.  B.:  Children  Well  and  Happy.  Published  under 
auspices  of  Mass.  State  Fed.  Women's  Clubs.  Manual  for 
the  Use  of  the  Girls'  Health  League  of  Mass.  Boston,  Le  Roy 
PhiUips,  1918. 

Duke,  Emma:  Infant  Mortality:  Results  of  a  Field  Study  in  John- 
town,  Pa.,  U.  S.  Dept.  of  Labor,  Children's  Bureau,  No.  9, 1915. 

Duke,  Emma  Duncan,  B.  S. :  Infant  Mortality:  Results  of  a  Field 
Study  in  Manchester,  N.  H.,  U.  S.  Dept.  of  Labor,  Children's 
Bureau,  No.  20,  1917. 

Duke,  Emma  Duncan,  B.  S. :  Infant  Mortality,  Montclair,  N.  J., 
Study  of  Infant  Mortality  in  a  Suburban  Community,  U.  S. 
Dept.  of  Labor,  Children's  Bureau,  No.  11,  1915. 

Griffiths,  J.  P.  C:  The  Care  of  the  Baby,  6th  ed.  revised,  Phila., 
Saunders,  1915. 

Kelley,  H.  W.,  Bradshaw,  M.  C:  Handbook  for  School  Nurses, 
N.  Y.,  MacmiUan,  1918. 

Levy,  JuUus:  Maternal  Nursing  considered  from  its  Evolutionary 
and  Biological  Aspects,  American  Medicine,  New  Series,  Vol.  X, 
No.  9,  pages  676-682, 1915,  also  Newark,  N.  J.,  Dept.  of  Health. 

N.  Y.  (state)  Dept  of  Health,  OutUne  for  organizing  and  directing 
"Little  Mothers'  Leagues,"  Albany. 

New  Zealand  Society  for  Health  of  Women  and  Children,  and 
Example  of  Methods  of  Baby-saving  Work  in  Small  Towns 
and  Rural  District,  Children's  Bureau  Pub.  No.  6. 

Struthers,  L.  R.:  School  Nurse,  N.  Y.,  Putnam,  1917. 

U.  S.  Dept.  of  Labor,  Children's  Bureau,  Breast  Feeding,  Care  of  the 
Mother,  Wash.,  D.  C,  1918. 

West,  Mrs.  Max:  Prenatal  Care,  U.  S.  Dept.  of  Labor,  Children's 
Bureau,  Washington,  D.  C,  Pub.  No.  4. 

West,  Mrs.  Max:  Infant  Care,  U.  S.  Dept.  of  Labor,  Children's 
Bureau,  Washington,  D.  C,  Pub.  No.  8. 

THE  WORKER'S  FOOD 

(Prepared  by  Miss  Katherine  Fisher,  Department  of  Household  and 
Institution  Administration,  Teachers'  College,  Columbia  Uni- 
versity.) 

U.  S.  Dept.  of  Labor:  Welfare  Work  in  British  Munition  Factories. 
Reprints  can  be  purchased  from  Supt.  of  Documents,  Govern- 
ment Printing  Office,    (Bulletin  22.) 


172  BIBLIOGRAPHY 

U.  S.  Dept.  of  Labor:  Bulletin  of  the  National  Association  of  Cor- 
poration Schools.  December,  1917.  130  E.  15th  Street,  New 
York. 

Whitney,  Anice  L.:  Lunch  Rooms  for  Employees.  "Monthly  Re- 
view," Bureau  of  Labor  Statistics,  U.  S.  Dept.  of  Labor,  De- 
cember, 1917. 

Morton,  Augustus  P. :  Welfare  Work  for  Civilian  Employees  of  the 
United  States.  "  Monthly  Review,"  Bureau  of  Labor  Statistics, 
U.  S.  Dept.  of  Labor,  August,  1918. 

Gnmi,  Fredk.  S. :  Restaurant  Facilities  for  Shipyard  Workers.  In- 
dustrial Relations  Division,  U.  S.  Shipping  Board,  Emergency 
Fleet  Corporation,  Philadelphia,  Pa. 

General  Electric  Co. :  The  Preparation  of  Foods  for  Factory  Employ- 
ees, General  Electric  Company,  Cleveland,  Ohio. 

Y.  W.  C.  A.:  Handbook  of  the  Association  Cafeteria,  National  Board 
of  the  Y.  W.  C.  A. 

Smedley,  Emma :  School  Lunch  Room  Management. 

Payser,  E.  R.:  A  Quiet  Factory  Lunch  Room.  Journal  of  Home 
Economics,  Oct.,  1911. 

Lage,  Katharine:  A  Lunch  Room  for  Working  Girls  in  which  Simple 
Instruction  is  given,  Journal  of  Home  Economics,  Nov.,  1910. 

Lage,  Katharine:  Institutional  Supplies,  Bureau  of  State  and  Mu- 
nicipal Research,  Baltimore,  Md. 

Smedley,  Emma :  Institution  Recipes. 

Smith,  Frances  L. :  Recipes  and  Menus  for  Fifty. 

Smith,  Frances  L. :  More  Recipes  and  Menus  for  Fifty. 

Nettleton,  Bertha  E.:  One  Hundred  Portion  War  Tim^  Recipes, 
Lippincott  &  Co.,  Philadelphia,  Pa. 

Kittredge,  Mabel  H. :  The  Home  and  its  Management,  Century  Co. 

Gibbs,  Winifred  S. :  The  Minimum  Cost  of  Living,  MacmiUan. 

Rose,  Mary  Swartz:  Feeding  the  Family,  Macmillan. 

Gibbs,  Winifred  S.:  Lessons  in  the  Proper  Feeding  of  the  Family, 
Society  for  Improving  the  Condition  of  the  Poor. 

McCoUum,  E.  O. :  The  Newer  Knowledge  of  Nutrition,  Macmillan. 

Stem  &  Spitz :  Food  for  the  Worker. 

Kinne  &  Cooley:  Foods  and  Household  Management,  MacmiUan. 

Balderston,  L.  R.:  Housewifery,  Lippincott. 

Lusk,  Graham :  The  Basis  of  Nutrition,  Yale  University  Press. 

Stiles,  P.  G. :  An  Adequate  Dish,  Saunders. 


BIBLIOGRAPHY  173 

INDUSTRIAL  RECREATION 

(Prepared  by  the  Playground  and  Recreation  Association 
of  America) 

1  Madison  Avenue,  New  York  City 

Application  may  be  made  direct  to  the  Playground  and  Recrea- 
tion Association  for  definite  information  about  folk  dances,  plays, 
music,  and  entertainments  suitable  for  industrial  centers. 

Boy  Scouts  of  America.  Literatiu-e  on  their  activities  and  organi- 
zation, may  be  obtained  from  Boy  Scouts  of  America,  Headquarters, 
200  Fifth  Avenue,  N.  Y.  C. 

Camp  Fire  Girl  hterature  may  be  had  by  applying  to  Camp 
Fire  Girls'  Headquarters,  31  E.  17th  Street,  N.  Y.  C. 

Girl  Scouts  of  America.  Literature  on  their  activities  may  be 
had  from  Girl  Scout  Headquarters,  1  Madison  Avenue,  N.  Y.  C. 

Pageants.  Outline  of  a  pageant  for  an  industrial  center  where 
there  is  very  Uttle  money  for  special  costuming  and  where  great 
numbers  of  men  and  women  must  be  used,  can  be  had  from  the 
Playground  and  Recreation  Association  of  America,  1  Madison 
Avenue,  New  York  City,  free  of  charge.  (Bulletin  No.  1  of  the 
Industrial  Series.) 

Chesley,  A.  M.:  Social  Activities  for  Men  and  Boys,  N.  Y.,  Assn. 
Press,  1910.  (A  book  taking  up  the  organization  and  manage- 
ment of  boys'  clubs;  "hikes,"  athletics,  programs  for  indoor 
track  meets;  suggestions  for  entertainments  for  all  sorts  of 
special  occasions  as  well  as  for  every  day.  A  book  that  fills 
the  need  for  every  type  of  entertainment  from  the  simplest  to 
the  most  elaborate.) 
Ferris,  H.  J.:  Girls'  Clubs,  N.  Y.,  Button,  1918  (illustrated).  (A 
book  containing  information  about  everything  connected  with 
girls'  clubs,  their  purpose,  organization  and  maintenance. 
Recommended  by  the  Girls'  Work  Department  of  the  National 
Board  of  the  Young  Women's  Christian  Association  as  an 
invaluable  help  in  organizing  and  managing  clubs.  Will  be 
useful  to  anyone  conducting  girls  clubs,  or  to  anyone  just 
starting  a  club.  A  practical  working  handbook.) 
MacKay,  C.  D.:  Patriotic  Drama  in  Your  Town,  N.  Y.,  Holt,  1918. 
(This  book  gives  simple,  inexpensive,  easily  produced  material 
for  4th  of  July  and  Christmas  that  could  be  readily  used  in 
industrial  centers.) 


174  BIBLIOGRAPHY 

Marot,  Helen:  Creative  Impulse  in  Industry,  N.  Y.,  Button,  1918. 
(A  book  which  goes  into  the  philosophical  as  well  as  the  prac- 
tical side  of  the  need  for  the  creative  life  in  industry.  "An 
effort  to  maintain  factory  efficiency  without  turning  workers 
into  dull  machines.") 

Weir,  L.  H.:  Vocational  Recreation  in  Indiana,  N.  Y.  C.  Plaj'^ground 
and  Recreation  Assn.  (Bulletin  of  the  Extension  Division 
of  Indiana  University.  Gives  a  broad,  practical  view  of  the 
whole  subject.  Particularly  useful  for  its  chapters  on  social 
and  educational  activities,  games,  playgrounds,  etc.). 

Weller,  C.  F.:  Recreation  in  Industries,  N.  Y.  C.  Playground  and 
Recreation  Assn.  (Takes  up  recreation  from  many  angles. 
Describes  theaters,  movies,  the  laying  out  of  playgrounds,  use 
of  leisure.  Gives  prices  of  playground  equipment.  Very  com- 
prehensive.) 


INDEX 


Accidents,  increase  of  reported, 
32;  industrial,  32,  33;  four 
classes  of,  38;  minor,  33;  pre- 
vention of,  10,  143 

Advertising,  see  first  aid,  ad- 
vertising of. 

Advice,  circulars  of,  146;  gratu- 
itous medical,  4 

Alcohol,  see  stimulants 

Americanization,  see  foreigners 

Applicant,  interview  with,  103; 
observation  physical  condition 
of,  107;  blank  form  for,  120 

Application  for  employment, 
blank  for,  109;  copy  of,  110 

Asphyxiation,  39,  160-163 

Babies,  supervision  of,  126;  well, 

care  of,  127;  how  to  find,  128 
Baby  welfare  work,  see  child 
Bibliography,  169 

Cancer,  prevention  of,  42 

Care,  prenatal,  29,  30 

Card,  wage,  time,  115;  average 
earnings,  116;  history.  111; 
identification,  113;  pass,  117 

Cathartics,  41 

Center,  industrial  nursing,  124; 
recreation  at,  124;  development 
of,  139;  the  house  for,  140;  as 
a  community  center,  29 

Charity,  30;  lunch  room  not  a,  143 

Charity  worker,  nurse  not  a,  15 


Check,  specimen  meal,  145,  146 

Child  welfare,  29,  30,  126-139 

Civic  association,  30 

Class,  mother's,  128 

Classes,  cooking,  147 

Clerk,  first  aid  record,  duties  of, 
53,  68 

Clinic,  baby,  127 

Clubs,  Httle  mothers',  139;  or- 
ganizing, ability  in,  11; 
woman's,  30 

Colds,  44 

Cooperation,  8,  10,  73;  with 
health  department,  28,  44;  with 
employment  department,  37; 
with  local  hospital,  42;  with 
employer,  29;  with  industrial 
physician,  23;  with  physicians, 
22,  with  workers,  26 

Community,  the  industrial  nurse 
and  the,  28-31 

Community,  resources  of  the,  28 

Committees,  management  of  in- 
dustrial nursing  by,  19,  20; 
management  of  lunch  room  by, 
144;  material  relief  by,  19 

Compensation,  industrial,  5; 
claims  for,  32;  settlement  of, 
32,  38;  the  industrial  nurse  as 
witness  in,  49,  for  industrial 
disease,  21 

Conference,  baby,  126;  helpful,  19 

Contagion,  control  of,  44,  45; 
medical    examination    for    pre- 


175 


176 


INDEX 


vention  of,  22;  in  industrial 
day  nursery,  137;  in  the  em- 
ployes' lunch  room,  143 

Day  book,  86;  sample  page,  87; 
duplicate  pages  for,  98;  for  each 
station,  59 

Dentist,  the,  43;  relation  of,  to 
workers,  43 

Department,  employment,  func- 
tion of,  101 

Detective,  the  industrial  nurse 
not  a,  16,  17 

Diet,  see  food 

Dietetics,  in  the  homes,  147; 
nurse's  knowledge  of,  148 

Dietitian,  19;  necessary  in  lunch 
room,  143;  the  industrial  nurse 
as,  143 

Directory,  of  plant,  28;  of  commu- 
nity, 28 

Disease,  industrial,  12,  79 

Dispensary,  evening,  29;  works,  29 

Doctor,  see  physician 

Dress,  uniform,  advantages  of, 
152,  157;  suggestions  for,  153 

Dressings,  plan  for  handling,  85; 
supplies  for,  61;  surgical,  61,  62 

Drowning,  39,  40,  160-163 

Drugs,  see  medicines 

Emergencies,  39,  40 

Employees,  dismissal  of,  105; 
new,  37;  interview  with,  121; 
requisition  for,  144 

Employer,  the  charitable,  2 

Employment  department,  see  de- 
partment, employment  man- 
agement, see  management,  em- 
ployment 

Epidemics,  44 


Ethics,  nursing,  78 

Etiquette,  professional,  23,  24 

Examination,  of  employees,  med- 
ical, 22,  79;  of  lunch  room  em- 
ployees, 143;  on  return  from 
illness,  79;  value  of  nurse  in,  23 

Eyes,  examination  of,  42,  120; 
strain  of,  43 

First  aid,  equipment,  56-64;  in- 
struction of  workers  in,  49 
inspection  of,  64;  plan  for,  51 
52,  53,  54;  rules,  38,  39,  40 
outfits  for  laymen,  34;  room 
7,  26,  27,  32;  location  of,  51 
rules  for,  159;  station,  64 
advertising  of,  34-37 

Food,  41,  142,  143;  in  workrooms, 
danger  of,  142;  for  injured 
worker,  59;  habits,  racial,  147 

Foreigners ;  Americanization  of, 
help  of  industrial  nurse  in,  4, 
71,  72,  149 

Foremen,  cooperation  with,  35, 
44,79 

Funds,  benefit,  4;  employers' 
objections  to,  5;  loan,  15;  pen- 
sion, 6;  sick,  4,  5 

Garden,  back  yard,  29;  nurse's,  29 
Gossip,  value  of,  36,  48 

Habits,  regular,  41;  of  worker,  43 
Handicapped,  22;  advantages  of, 
101;  adjustment  of  work  to,  102 
Headaches,  41 
Hemorrhage,  39,  40 
History,  industrial  nursing,  1-8 
Home  visiting,  necessity  of,  70 
Hospital,  industrial,  1,  21;  com- 
pany, 124 


INDEX 


177 


House,  nurse's,  124;  objections  to, 

125 
Hygiene,  personal  instruction  in, 

48 
Hysteria,  42 

Illness,  prevention  of,  10,  42,  143 
Industrial  nurse,  see  trained  nurse 
Infant  welfare,  see  child 
Infections,  32,  34,  35,  37. 

Labor,  disturbances,  27;  turn- 
over, 5,  99 

Laundry,  bag,  63;  of  uniforms, 
157;  work,  63 

Laws,  industrial,  relation  of  nurse 
to,  49 

Library,  circulating,  126;  pro- 
fessional, 66 

Linen,  first  aid  room,  63 

Loan  closet,  126 

Loyalty,  to  employer,  27;  to 
senior,  154 

Lunch  room,  142;  not  a  charity, 
143,  144;  policy  of  company,  144 

Malingering,  3;  duty  of  nurse  in 

case  of,  17 
Management     employment,     for 

nurses,  99;  duties  of  nurse  in, 

104 
Maternity,    benefits,    6;    out    of 

wedlock,  46 
Medicines,    giving    of,    33,    41; 

promiscuous  administration  of, 

43;  list  of,  for  first  aid  room,  60 
Meetings,  for  conference,  19,  20; 

informal,  85 
Noon  hour,  47,  48,  79 
Nuisances,  industrial,  abatement 

of,  28 


Nurse,  see  trained  nurse  in  indus- 
try 
Nurse,  industrial,  supervising,  155 
Nursery,  industrial,  day,  133 
Nm-sing,  industrial,  beginning  of, 
33;  cost  of,  4,  67,  68;  develop- 
ment of,  4,  7;  growth  of,  7,  8; 
advantages  to  the  nurse  of,  156; 
school,  30;  payment  for,  16 

Orders,  first  aid,  standing,  26,  33, 
39;  visiting  nursing,  76;  written, 
98 

Patients,  first  aid,  four  classes  of, 
38;  return  of,  for  redressings,  82 

Periodical,  pubUshed  by  employes, 
119,  140;  expenses  of,  from 
proceeds  of  lunch  room,  144 

Personnel,  68 

Physician,  family,  22,  25,  41,  44, 
45,  78,  79;  and  baby  conference, 
127;  and  sick  baby,  130;  habit 
of  employing,  130;  supervision 
of  pregnant  women  by,  131, 
132;  private,  22,  25,  41,  45,  77; 
attending,  43,  76;  industrial, 
18-44,  54,  61,  64,  77;  financial 
arrangements  with,  24;  part 
time,  23,  25;  organization  rests 
with,  89;  and  baby  clinic,  127; 
in  employment  office,  100;  rela- 
tion of  industrial  nurse  to,  150 

Record  card,  industrial,  93;  com- 
bination employment  and  nurs- 
ing, 112 
Record  keeping,  cooperation  in,  92 
Record  keeping,  plan  for,  93 
Records  of  industrial  nurse,   21, 
35,  38,  41,  46,  49;  classification 


178 


INDEX 


of,  94;  interpretation  of,  91; 
necessity  of,  91;  use  of,  by  in- 
dustrial physician,  92;  stand- 
ards for,  91 

Records  of  industrial  visiting 
nurse,  79 

Reference,  request  for,  110 

Relief,  material,  14,  15,  19,  20, 
21 

Reports,  16,  21,  35,  46;  daily,  86, 
95;  monthly  and  annual,  form 
for,  97;  nonstatistical,  96,  154 

Safety,  the  industrial  nurse  a  pro- 
vision for,  15;  lunch  room  con- 
nected with,  143 

Schedule,  weekly,  87 

Service  to  employees,  117 

Shock,  39,  40;  electric,  162 

Social  questions  in  first  aid  room, 
45 

Station,  milk,  130 

SteriUzer,  154 

Stimulants,  61;  alcoholic,  60 

Strike,  Pullman,  1 

Supervision,  of  industrial  nursing 
in  a  number  of  plants,  155; 
medical,  2,  44;  prenatal,  130; 
by  visiting  nurse  association,  74 

SuppUes,  60,  62,  63;  economy  in 
use  of,  67 

Surgeon,  see  physician 

Tests,  psychological,  103 

Time,  economy,  of  worker's,  47; 

of  nurse's,  47 
Toothache,  43 
Trained  nurse  in  industry,   first 

entered,   2;  contract  for,    150; 

early  work  of,  2;  as  a  general 

nurse,   73;  entry  to  plant,   6; 


dependence  of  worker  on,  43; 
duties  of,  18,  21 ;  growth  of  work 
of,  68,  69;  history  of,  1-8;  not 
a  detective,  16,  17;  not  a  sub- 
stitute for  a  physician,  23,  151; 
preparation  of,  for  executive 
position,  13;  qualifications  of, 
9,  10,  11;  quarters  for,  152; 
special  training  of,  9,  11,  12,  19 
Tuberculosis,  30,  42 

Uniforms,  see  dress 

Varicose  veins,  107 

Visiting  nurse  association,  16, 
29,  42,  74,  75;  cooperation  with, 
73,  74;  workers'  objections  to, 
75 

Visiting  nurse,  general  rule  for,  76 

Visiting  nurse  in  industry,  and  the 
physician,  72;  responsibilities 
and  duties  of,  79 

Visiting  nurse  service  in  industry, 
organization  of,  72 

Visiting  nursing,  industrial,  29,  84; 
beginning  of,  70,  71;  develop- 
ment of,  71-79;  method  in 
getting  calls  for,  77;  standards 
for,  29;  technique  of,  75,  79 

Welfare,     industrial,     1,     3,     4; 

community,  28;  cooperation  in, 

140 
Welfare  department,  18 
Welfare  manager,    the  nurse  as, 

141 
Welfare  superintendent,  18 
Welfare  worker,  45 
Women  in  industry,  6;  causes  of 

presence  of,  129;  pregnant,  131; 

unmarried,  pregnant,  46 


INDEX 


179 


Worker,  injured,  relatives  of,  39, 
40;  sick,  41,  42,  43,  44;  personal 
affairs  of,  37,  45,  46,  47,  78 

Workers,  organizations  of,  19,  21, 
22,  25,  48,  68,  74;  employment 
of  nurse  by,  2,  3,  19;  meetings 


of  representatives  of,  19;  pro- 
vision of  medical  care  by,  21 

Work  rooms,  visits  to,  37;  after 
accidents,  40 

Wounds,  extensive,  treatment  of, 
39,  40;  infected,  see  infections 


Printed  in  the  United  States  of  America. 


7  *  7  618 


PUBLIC  HEALTH  LIBRARY 


U.C.BERKELEY  LIBRARIES 


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